Comportamiento de la patología biliar aguda y su manejo en el servicio de trauma y emergencia del Hospital "Vicente Corral Moscoso" Cuenca. Enero a junio de 2014

La patología biliar afecta a un gran porcentaje de la población adulta, motivo por el cual su tratamiento en la actualidad ha cambiado hacia un nuevo paradigma de cuidado bajo el concepto de “Acute Care Surgery” (ACS) 1 el cual se caracteriza por priorizar la valoración integral del paciente e intervención precoz de la patología. En el Hospital Vicente Corral Moscoso (HVCM) bajo este modelo ACS, y mediante la utilización de protocolos estandarizados se ha logrado dar un giro importante en el tratamiento oportuno de la patología biliar mediante la utilización de herramientas habituales como pruebas de laboratorio, imagenología y si es el caso, la resolución quirúrgica mediante técnica mínimamente invasiva o por vía convencional. OBJETIVO: Describir el comportamiento de la patología biliar y su manejo en el servicio de Trauma y Emergencias del Hospital “Vicente Corral Moscoso”, durante el período de enero a junio de 2014, bajo el modelo ACS. MÉTODOS: Estudio descriptivo transversal, que analizó los casos de colecistitis aguda litiásica (CAL), coledocolitiasis, pancreatitis aguda biliar (PAB) y su manejo, registrado en la base de datos digital del servicio de Emergencias del Hospital Vicente Corral Moscoso, bajo criterios clínicos, de laboratorio e imagenológicos, durante el periodo de enero a junio del 2014. RESULTADOS: El estudio contó con un total de 240 pacientes atendidos en el servicio de Trauma y Emergencia del HVCM, durante el periodo de enero a junio de 2014. La patología en orden de frecuencia fue: en un 47%, la Coledocolitiasis; 35% colecistitis aguda y, pancreatitis aguda biliar 18%. La prevalencia fue mayor en el sexo femenino en un 85%, 67%, y 81% respectivamente y el tratamiento se adaptó a cada patología. 1 Acute Care Surgery” (ACS): si bien no existe una definición literal hace referencia a una disciplina tripartita que engloba la cirugía de trauma, general en emergencias y cuidados críticos quirúrgicos, y que prioriza la identificación y manejo de las patologías potencialmente letales y de alta morbilidad. En nuestro medio lo más próximo a la definición seria Cirugía de Trauma y Emergencias. El manejo de la pancreatitis aguda biliar (PAB) bajo el concepto de cuidado agudo de pacientes quirúrgicos o “Acute Care Surgery” hace indispensable una intervención oportuna y temprana, utilizando todos los recursos disponibles para un manejo integral. CONCLUSIONES: La implementación del modelo de Cirugía de Trauma y Emergencias en nuestra institución ha logrado un manejo integral de colecistitis aguda litiásica, pancreatitis aguda biliar y coledocolitiasis, disminuyendo las complicaciones asociadas y evitando las recidivas de cuadros de mayor gravedad.

Implémentation sur FPGA de l’algorithme MUSIC sur antenne-réseau expérimentale à 10 GHz

Les techniques des directions d’arrivée (DOA) sont une voie prometteuse pour accroitre la capacité des systèmes et les services de télécommunications en permettant de mieux estimer le canal radio-mobile. Elles permettent aussi de suivre précisément des usagers cellulaires pour orienter les faisceaux d’antennes dans leur direction. S’inscrivant dans ce contexte, ce présent mémoire décrit étape par étape l’implémentation de l’algorithme de haut niveau MUSIC (MUltiple SIgnal Classification) sur une plateforme FPGA afin de déterminer en temps réel l’angle d’arrivée d’une ou des sources incidentes à un réseau d’antennes. Le concept du prototypage rapide des lois de commande (RCP) avec les outils de XilinxTM System generator (XSG) et du MBDK (Model Based Design Kit) de NutaqTM est le concept de développement utilisé. Ce concept se base sur une programmation de code haut niveau à travers des modèles, pour générer automatiquement un code de bas niveau. Une attention particulière est portée sur la méthode choisie pour résoudre le problème de la décomposition en valeurs et vecteurs propres de la matrice complexe de covariance par l’algorithme de Jacobi. L’architecture mise en place implémentant cette dernière dans le FPGA (Field Programmable Gate Array) est détaillée. Par ailleurs, il est prouvé que MUSIC ne peut effectuer une estimation intéressante de la position des sources sans une calibration préalable du réseau d’antennes. Ainsi, la technique de calibration par matrice G utilisée dans ce projet est présentée, en plus de son modèle d’implémentation. Enfin, les résultats expérimentaux du système mis à l’épreuve dans un environnement réel en présence d’une source puis de deux sources fortement corrélées sont illustrés et analysés.

Implementation of Quantitative Reaction-based Model Refinement

Building a computational model for complex biological systems is an iterative process. It starts from an abstraction of the process and then incorporates more details regarding the specific biochemical reactions which results in the change of the model fit. Meanwhile, the model’s numerical properties such as its numerical fit and validation should be preserved. However, refitting the model after each refinement iteration is computationally expensive resource-wise. There is an alternative approach which ensures the model fit preservation without the need to refit the model after each refinement iteration. And this approach is known as quantitative model refinement. The aim of this thesis is to develop and implement a tool called ModelRef which does the quantitative model refinement automatically. It is both implemented as a stand-alone Java application and as one of Anduril framework components. ModelRef performs data refinement of a model and generates the results in two different well known formats (SBML and CPS formats). The development of this tool successfully reduces the time and resource needed and the errors generated as well by traditional reiteration of the whole model to perform the fitting procedure.

Impact of a program for the prevention of traffic accidents in a Southern Brazilian city: a model for implementation in a developing country

Background: Traffic accidents constitute the main cause of death in the first decades of life. Traumatic brain injury is the event most responsible for the severity of these accidents. The SBN started an educational program for the prevention of traffic accidents, adapted from the American model ""Think First"" to the Brazilian environment, since 1995, with special effort devoted to the prevention of TBI by using seat belts and motorcycle helmets. The objective of the present study was to set up a traffic accident prevention program based on the adapted Think First and to evaluate its impact by comparing epidemiological variables before and after the beginning of the program. Methods: The program was executed in Maringa city, from September 2004 to August 2005, with educational actions targeting the entire population, especially teenagers and young adults. The program was implemented by building a network of information facilitators and multipliers inside the organized civil society, with widespread population dissemination. To measure the impact of the program, a specific software was developed for the storage and processing of the epidemiological variables. Results: The results showed a reduction of trauma severity due to traffic accidents after the execution of the program, mainly TBI. Conclusions: The adapted Think First was systematically implemented and its impact measured for the first time in Brazil, revealing the usefulness of the program for reducing trauma and TBI severity in traffic accidents through public education and representing a standardized model of implementation in a developing country. (C) 2009 Elsevier Inc. All rights reserved.

The gambin model provides a superior fit to species abundance distributions with a single free parameter : evidence, implementation and interpretation

The species abundance distribution (SAD) has been a central focus of community ecology for over fifty years, and is currently the subject of widespread renewed interest. The gambin model has recently been proposed as a model that provides a superior fit to commonly preferred SAD models. It has also been argued that the model's single parameter (α) presents a potentially informative ecological diversity metric, because it summarises the shape of the SAD in a single number. Despite this potential, few empirical tests of the model have been undertaken, perhaps because the necessary methods and software for fitting the model have not existed. Here, we derive a maximum likelihood method to fit the model, and use it to undertake a comprehensive comparative analysis of the fit of the gambin model. The functions and computational code to fit the model are incorporated in a newly developed free-to-download R package (gambin). We test the gambin model using a variety of datasets and compare the fit of the gambin model to fits obtained using the Poisson lognormal, logseries and zero-sum multinomial distributions. We found that gambin almost universally provided a better fit to the data and that the fit was consistent for a variety of sample grain sizes. We demonstrate how α can be used to differentiate intelligibly between community structures of Azorean arthropods sampled in different land use types. We conclude that gambin presents a flexible model capable of fitting a wide variety of observed SAD data, while providing a useful index of SAD form in its single fitted parameter. As such, gambin has wide potential applicability in the study of SADs, and ecology more generally.

Model driven development implementation of a control systems user interfaces specification tool

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia Informática

Implementation and validation of a strain rate dependent anisotropic continuum model for masonry

A newly developed strain rate dependent anisotropic continuum model is proposed for impact and blast applications in masonry. The present model adopted the usual approach of considering different yield criteria in tension and compression. The analysis of unreinforced block work masonry walls subjected to impact is carried out to validate the capability of the model. Comparison of the numerical predictions and test data revealed good agreement. Next, a parametric study is conducted to evaluate the influence of the tensile strengths along the three orthogonal directions and of the wall thickness on the global behavior of masonry walls.

A Wireless Mesh Network NS-3 Simulation Model: Implementation and Performance Comparison With a Real Test-Bed

Wireless mesh networks present an attractive communication solution for various research and industrial projects. However, in many cases, the appropriate preliminary calculations which allow predicting the network behavior have to be made before the actual deployment. For such purposes, network simulation environments emulating the real network operation are often used. Within this paper, a behavior comparison of real wireless mesh network (based on 802.11s amendment) and the simulated one has been performed. The main objective of this work is to measure performance parameters of a real 802.11s wireless mesh network (average UDP throughput and average one-way delay) and compare the derived results with characteristics of a simulated wireless mesh network created with the NS-3 network simulation tool. Then, the results from both networks are compared and the corresponding conclusion is made. The corresponding results were derived from simulation model and real-worldtest-bed, showing that the behavior of both networks is similar. It confirms that the NS-3 simulation model is accurate and can be used in further research studies.

How Low Can We Go in Contrast-Enhanced CT Imaging of the Chest?: A Dose-Finding Cadaver Study Using the Model-based Iterative Image Reconstruction Approach.

RATIONALE AND OBJECTIVES: Dose reduction may compromise patients because of a decrease of image quality. Therefore, the amount of dose savings in new dose-reduction techniques needs to be thoroughly assessed. To avoid repeated studies in one patient, chest computed tomography (CT) scans with different dose levels were performed in corpses comparing model-based iterative reconstruction (MBIR) as a tool to enhance image quality with current standard full-dose imaging. MATERIALS AND METHODS: Twenty-five human cadavers were scanned (CT HD750) after contrast medium injection at different, decreasing dose levels D0-D5 and respectively reconstructed with MBIR. The data at full-dose level, D0, have been additionally reconstructed with standard adaptive statistical iterative reconstruction (ASIR), which represented the full-dose baseline reference (FDBR). Two radiologists independently compared image quality (IQ) in 3-mm multiplanar reformations for soft-tissue evaluation of D0-D5 to FDBR (-2, diagnostically inferior; -1, inferior; 0, equal; +1, superior; and +2, diagnostically superior). For statistical analysis, the intraclass correlation coefficient (ICC) and the Wilcoxon test were used. RESULTS: Mean CT dose index values (mGy) were as follows: D0/FDBR = 10.1 ± 1.7, D1 = 6.2 ± 2.8, D2 = 5.7 ± 2.7, D3 = 3.5 ± 1.9, D4 = 1.8 ± 1.0, and D5 = 0.9 ± 0.5. Mean IQ ratings were as follows: D0 = +1.8 ± 0.2, D1 = +1.5 ± 0.3, D2 = +1.1 ± 0.3, D3 = +0.7 ± 0.5, D4 = +0.1 ± 0.5, and D5 = -1.2 ± 0.5. All values demonstrated a significant difference to baseline (P < .05), except mean IQ for D4 (P = .61). ICC was 0.91. CONCLUSIONS: Compared to ASIR, MBIR allowed for a significant dose reduction of 82% without impairment of IQ. This resulted in a calculated mean effective dose below 1 mSv.

Model-based iterative reconstruction in pediatric chest CT: assessment of image quality in a prospective study of children with cystic fibrosis.

BACKGROUND: The potential effects of ionizing radiation are of particular concern in children. The model-based iterative reconstruction VEO(TM) is a technique commercialized to improve image quality and reduce noise compared with the filtered back-projection (FBP) method. OBJECTIVE: To evaluate the potential of VEO(TM) on diagnostic image quality and dose reduction in pediatric chest CT examinations. MATERIALS AND METHODS: Twenty children (mean 11.4 years) with cystic fibrosis underwent either a standard CT or a moderately reduced-dose CT plus a minimum-dose CT performed at 100 kVp. Reduced-dose CT examinations consisted of two consecutive acquisitions: one moderately reduced-dose CT with increased noise index (NI = 70) and one minimum-dose CT at CTDIvol 0.14 mGy. Standard CTs were reconstructed using the FBP method while low-dose CTs were reconstructed using FBP and VEO. Two senior radiologists evaluated diagnostic image quality independently by scoring anatomical structures using a four-point scale (1 = excellent, 2 = clear, 3 = diminished, 4 = non-diagnostic). Standard deviation (SD) and signal-to-noise ratio (SNR) were also computed. RESULTS: At moderately reduced doses, VEO images had significantly lower SD (P < 0.001) and higher SNR (P < 0.05) in comparison to filtered back-projection images. Further improvements were obtained at minimum-dose CT. The best diagnostic image quality was obtained with VEO at minimum-dose CT for the small structures (subpleural vessels and lung fissures) (P < 0.001). The potential for dose reduction was dependent on the diagnostic task because of the modification of the image texture produced by this reconstruction. CONCLUSIONS: At minimum-dose CT, VEO enables important dose reduction depending on the clinical indication and makes visible certain small structures that were not perceptible with filtered back-projection.

Update on the non-prewhitening model observer in computed tomography for the assessment of the adaptive statistical and model-based iterative reconstruction algorithms.

The state of the art to describe image quality in medical imaging is to assess the performance of an observer conducting a task of clinical interest. This can be done by using a model observer leading to a figure of merit such as the signal-to-noise ratio (SNR). Using the non-prewhitening (NPW) model observer, we objectively characterised the evolution of its figure of merit in various acquisition conditions. The NPW model observer usually requires the use of the modulation transfer function (MTF) as well as noise power spectra. However, although the computation of the MTF poses no problem when dealing with the traditional filtered back-projection (FBP) algorithm, this is not the case when using iterative reconstruction (IR) algorithms, such as adaptive statistical iterative reconstruction (ASIR) or model-based iterative reconstruction (MBIR). Given that the target transfer function (TTF) had already shown it could accurately express the system resolution even with non-linear algorithms, we decided to tune the NPW model observer, replacing the standard MTF by the TTF. It was estimated using a custom-made phantom containing cylindrical inserts surrounded by water. The contrast differences between the inserts and water were plotted for each acquisition condition. Then, mathematical transformations were performed leading to the TTF. As expected, the first results showed a dependency of the image contrast and noise levels on the TTF for both ASIR and MBIR. Moreover, FBP also proved to be dependent of the contrast and noise when using the lung kernel. Those results were then introduced in the NPW model observer. We observed an enhancement of SNR every time we switched from FBP to ASIR to MBIR. IR algorithms greatly improve image quality, especially in low-dose conditions. Based on our results, the use of MBIR could lead to further dose reduction in several clinical applications.