Automated low flow pump system for the treatment of refractory ascites: A multi-center safety and efficacy study

BACKGROUND & AIMS: Refractory ascites (RA) affects 10% of patients with advanced cirrhosis and ascites. Usual therapy includes large volume paracentesis, and in selected patients, a transjugular portosystemic shunt (TIPS). These therapies may be associated with increased morbidity: paracentesis may induce circulatory dysfunction and impair quality of life and TIPS may induce encephalopathy and is associated with increased mortality in patients with severe liver dysfunction. We present the results of a multicenter, non-randomized trial to assess the safety and efficacy of a new automated pump system for treatment of RA. METHODS: Forty patients at 9 centers (February 2010-June 2011) received an implanted pump for the automated removal of ascites from the peritoneal cavity into the bladder, from where it was eliminated through normal urination. Patients were followed-up for 6months. The primary study outcome was safety. Secondary outcomes included recurrence of tense ascites and pump performance. RESULTS: Surgical complications occurred early in the study and became less frequent. The pump system removed 90% of the ascites and significantly reduced the median number of large volume paracentesis per month [3.4 (range 1-6) vs. 0.2 (range 0-4); p <0.01]. Cirrhosis-related adverse events decreased along follow-up. CONCLUSIONS: The automated pump seems an efficacious tool to move out ascites from the peritoneal cavity to the bladder. Its safety is still moderate, but a broad use in different countries will improve the surgical technique as well as the medical surveillance. A prospective randomized clinical trial vs. large volume paracentesis is underway to confirm these preliminary results.

Multi-phase postmortem CT angiography: recognizing technique-related artefacts and pitfalls

BACKGROUND AND PURPOSE Multi-phase postmortem CT angiography (MPMCTA) is increasingly being recognized as a valuable adjunct medicolegal tool to explore the vascular system. Adequate interpretation, however, requires knowledge about the most common technique-related artefacts. The purpose of this study was to identify and index the possible artefacts related to MPMCTA. MATERIAL AND METHODS An experienced radiologist blinded to all clinical and forensic data retrospectively reviewed 49 MPMCTAs. Each angiographic phase, i.e. arterial, venous and dynamic, was analysed separately to identify phase-specific artefacts based on location and aspect. RESULTS Incomplete contrast filling of the cerebral venous system was the most commonly encountered artefact, followed by contrast agent layering in the lumen of the thoracic aorta. Enhancement or so-called oedematization of the digestive system mucosa was also frequently observed. CONCLUSION All MPMCTA artefacts observed and described here are reproducible and easily identifiable. Knowledge about these artefacts is important to avoid misinterpreting them as pathological findings.

Digital multi-text editions from scratch to electronic performance. Transcription and collation routines transformed in a flexible database system

The poster demonstrates the preparatory steps of a digital multi-text edition that are abstracted from the experiences made in the Parzival Project, based at the University of Bern, the Berlin-Brandenburg Academy of Sciences and the University of Erlangen. This edition of Wolfram von Eschenbach’s German Grail novel, written shortly after 1200 and transmitted during several centuries in ca. hundred witnesses, has now been completed by more than a half of the textual corpus.

Novel emboli protection system during cardiac surgery: a multi-center, randomized, clinical trial.

BACKGROUND Stroke is a major cause of morbidity and mortality during open-heart surgery. Up to 60% of intraoperative cerebral events are emboli induced. This randomized, controlled, multicenter trial is the first human study evaluating the safety and efficacy of a novel aortic cannula producing simultaneous forward flow and backward suction for extracting solid and gaseous emboli from the ascending aorta and aortic arch upon their intraoperative release. METHODS Sixty-six patients (25 females; 68±10 years) undergoing elective aortic valve replacement surgery, with or without coronary artery bypass graft surgery, were randomized to the use of the CardioGard (CardioGard Medical, Or-Yehuda, Israel) Emboli Protection cannula ("treatment") or a standard ("control") aortic cannula. The primary endpoint was the volume of new brain lesions measured by diffusion-weighted magnetic resonance imaging (DW-MRI), performed preoperatively and postoperatively. Device safety was investigated by comparisons of complications rate, namely neurologic events, stroke, renal insufficiency and death. RESULTS Of 66 patients (34 in the treatment group), 51 completed the presurgery and postsurgery MRI (27 in the treatment group). The volume of new brain lesion for the treatment group was (mean±standard error of the mean) 44.00±64.00 versus 126.56±28.74 mm3 in the control group (p=0.004). Of the treatment group, 41% demonstrated new postoperative lesions versus 66% in the control group (p=0.03). The complication rate was comparable in both groups. CONCLUSIONS The CardioGard cannula is safe and efficient in use during open-heart surgery. Efficacy was demonstrated by the removal of a substantial amount of emboli, a significant reduction in the volume of new brain lesions, and the percentage of patients experiencing new brain lesions.

Multi-Model Data Fusion to Improve an Early Warning System for Hypo-/Hyperglycemic Events

Correct predictions of future blood glucose levels in individuals with Type 1 Diabetes (T1D) can be used to provide early warning of upcoming hypo-/hyperglycemic events and thus to improve the patient's safety. To increase prediction accuracy and efficiency, various approaches have been proposed which combine multiple predictors to produce superior results compared to single predictors. Three methods for model fusion are presented and comparatively assessed. Data from 23 T1D subjects under sensor-augmented pump (SAP) therapy were used in two adaptive data-driven models (an autoregressive model with output correction - cARX, and a recurrent neural network - RNN). Data fusion techniques based on i) Dempster-Shafer Evidential Theory (DST), ii) Genetic Algorithms (GA), and iii) Genetic Programming (GP) were used to merge the complimentary performances of the prediction models. The fused output is used in a warning algorithm to issue alarms of upcoming hypo-/hyperglycemic events. The fusion schemes showed improved performance with lower root mean square errors, lower time lags, and higher correlation. In the warning algorithm, median daily false alarms (DFA) of 0.25%, and 100% correct alarms (CA) were obtained for both event types. The detection times (DT) before occurrence of events were 13.0 and 12.1 min respectively for hypo-/hyperglycemic events. Compared to the cARX and RNN models, and a linear fusion of the two, the proposed fusion schemes represents a significant improvement.

Multi-microphone recordings (EigenMike32) inside a WFS system (Iosono) through Ambisonics techniques using Matlab

El audio multicanal ha avanzado a pasos agigantados en los últimos años, y no solo en las técnicas de reproducción, sino que en las de capitación también. Por eso en este proyecto se encuentran ambas cosas: un array microfónico, EigenMike32 de MH Acoustics, y un sistema de reproducción con tecnología Wave Field Synthesis, instalado Iosono en la Jade Höchscule Oldenburg. Para enlazar estos dos puntos de la cadena de audio se proponen dos tipos distintos de codificación: la reproducción de la toma horizontal del EigenMike32; y el 3er orden de Ambisonics (High Order Ambisonics, HOA), una técnica de codificación basada en Armónicos Esféricos mediante la cual se simula el campo acústico en vez de simular las distintas fuentes. Ambas se desarrollaron en el entorno Matlab y apoyadas por la colección de scripts de Isophonics llamada Spatial Audio Matlab Toolbox. Para probar éstas se llevaron a cabo una serie de test en los que se las comparó con las grabaciones realizadas a la vez con un Dummy Head, a la que se supone el método más aproximado a nuestro modo de escucha. Estas pruebas incluían otras grabaciones hechas con un Doble MS de Schoeps que se explican en el proyecto “Sally”. La forma de realizar éstas fue, una batería de 4 audios repetida 4 veces para cada una de las situaciones garbadas (una conversación, una clase, una calle y un comedor universitario). Los resultados fueron inesperados, ya que la codificación del tercer orden de HOA quedo por debajo de la valoración Buena, posiblemente debido a la introducción de material hecho para un array tridimensional dentro de uno de 2 dimensiones. Por el otro lado, la codificación que consistía en extraer los micrófonos del plano horizontal se mantuvo en el nivel de Buena en todas las situaciones. Se concluye que HOA debe seguir siendo probado con mayores conocimientos sobre Armónicos Esféricos; mientras que el otro codificador, mucho más sencillo, puede ser usado para situaciones sin mucha complejidad en cuanto a espacialidad. In the last years the multichannel audio has increased in leaps and bounds and not only in the playback techniques, but also in the recording ones. That is the reason of both things being in this project: a microphone array, EigenMike32 from MH Acoustics; and a playback system with Wave Field Synthesis technology, installed by Iosono in Jade Höchscule Oldenburg. To link these two points of the audio chain, 2 different kinds of codification are proposed: the reproduction of the EigenMike32´s horizontal take, and the Ambisonics´ third order (High Order Ambisonics, HOA), a codification technique based in Spherical Harmonics through which the acoustic field is simulated instead of the different sound sources. Both have been developed inside Matlab´s environment and supported by the Isophonics´ scripts collection called Spatial Audio Matlab Toolbox. To test these, a serial of tests were made in which they were compared with recordings made at the time by a Dummy Head, which is supposed to be the closest method to our hearing way. These tests included other recording and codifications made by a Double MS (DMS) from Schoeps which are explained in the project named “3D audio rendering through Ambisonics techniques: from multi-microphone recordings (DMS Schoeps) to a WFS system, through Matlab”. The way to perform the tests was, a collection made of 4 audios repeated 4 times for each recorded situation (a chat, a class, a street and college canteen or Mensa). The results were unexpected, because the HOA´s third order stood under the Well valuation, possibly caused by introducing material made for a tridimensional array inside one made only by 2 dimensions. On the other hand, the codification that consisted of extracting the horizontal plane microphones kept the Well valuation in all the situations. It is concluded that HOA should keep being tested with larger knowledge about Spherical Harmonics; while the other coder, quite simpler, can be used for situations without a lot of complexity with regards to spatiality.

Some techniques for automated, resource-aware distributed and mobile computing in a multi-paradigm programming system

Distributed parallel execution systems speed up applications by splitting tasks into processes whose execution is assigned to different receiving nodes in a high-bandwidth network. On the distributing side, a fundamental problem is grouping and scheduling such tasks such that each one involves sufñcient computational cost when compared to the task creation and communication costs and other such practical overheads. On the receiving side, an important issue is to have some assurance of the correctness and characteristics of the code received and also of the kind of load the particular task is going to pose, which can be specified by means of certificates. In this paper we present in a tutorial way a number of general solutions to these problems, and illustrate them through their implementation in the Ciao multi-paradigm language and program development environment. This system includes facilities for parallel and distributed execution, an assertion language for specifying complex programs properties (including safety and resource-related properties), and compile-time and run-time tools for performing automated parallelization and resource control, as well as certification of programs with resource consumption assurances and efñcient checking of such certificates.

The CIAO Multi-Dialect Compiler and System: An Experimentation Workbench for Future (C)LP Systems

CIAO is an advanced programming environment supporting Logic and Constraint programming. It offers a simple concurrent kernel on top of which declarative and non-declarative extensions are added via librarles. Librarles are available for supporting the ISOProlog standard, several constraint domains, functional and higher order programming, concurrent and distributed programming, internet programming, and others. The source language allows declaring properties of predicates via assertions, including types and modes. Such properties are checked at compile-time or at run-time. The compiler and system architecture are designed to natively support modular global analysis, with the two objectives of proving properties in assertions and performing program optimizations, including transparently exploiting parallelism in programs. The purpose of this paper is to report on recent progress made in the context of the CIAO system, with special emphasis on the capabilities of the compiler, the techniques used for supporting such capabilities, and the results in the áreas of program analysis and transformation already obtained with the system.

The CIAO multi-dialect compiler and system: An experimentation workbench for future (C)LP systems

Abstract is not available.

The CIAO multi-dialect compiler and system: A demo and status report

Abstract is not available

Open multi-technology building energy management system

Energy Efficiency is one of the goals of the Smart Building initiatives. This paper presents an Open Energy Management System which consists of an ontology-based multi-technology platform and a wireless transducer network using 6LoWPAN communication technology. The system allows the integration of several building automation protocols and eases the development of different kind of services to make use of them. The system has been implemented and tested in the Energy Efficiency Research Facility at CeDInt-UPM.

Commonalities between networking in multiplayer computer games and negotiation processes in a future multi-layered Air Traffic Management (ATM) system

First, this paper describes a future layered Air Traffic Management (ATM) system centred in the execution phase of flights. The layered ATM model is based on the work currently performed by SESAR [1] and takes into account the availability of accurate and updated flight information ?seen by all? across the European airspace. This shared information of each flight will be referred as Reference Business Trajectory (RBT). In the layered ATM system, exchanges of information will involve several actors (human or automatic), which will have varying time horizons, areas of responsibility and tasks. Second, the paper will identify the need to define the negotiation processes required to agree revisions to the RBT in the layered ATM system. Third, the final objective of the paper is to bring to the attention of researchers and engineers the communalities between multi-player games and Collaborative Decision Making processes (CDM) in a layered ATM system