Management of Pharyngeal Fistulas After Anterior Cervical Spine Surgery: A Treatment Algorithm for Severe Complications.

STUDY DESIGN:: Retrospective database- query to identify all anterior spinal approaches. OBJECTIVES:: To assess all patients with pharyngo-cutaneous fistulas after anterior cervical spine surgery. SUMMARY OF BACKGROUND DATA:: Patients treated in University of Heidelberg Spine Medical Center, Spinal Cord Injury Unit and Department of Otolaryngology (Germany), between 2005 and 2011 with the diagnosis of pharyngo-cutaneous fistulas. METHODS:: We conducted a retrospective study on 5 patients between 2005 and 2011 with PCF after ACSS, their therapy management and outcome according to radiologic data and patient charts. RESULTS:: Upon presentation 4 patients were paraplegic. 2 had PCF arising from one piriform sinus, two patients from the posterior pharyngeal wall and piriform sinus combined and one patient only from the posterior pharyngeal wall. 2 had previous unsuccessful surgical repair elsewhere and 1 had prior radiation therapy. In 3 patients speech and swallowing could be completely restored, 2 patients died. Both were paraplegic. The patients needed an average of 2-3 procedures for complete functional recovery consisting of primary closure with various vascularised regional flaps and refining laser procedures supplemented with negative pressure wound therapy where needed. CONCLUSION:: Based on our experience we are able to provide a treatment algorithm that indicates that chronic as opposed to acute fistulas require a primary surgical closure combined with a vascularised flap that should be accompanied by the immediate application of a negative pressure wound therapy. We also conclude that particularly in paraplegic patients suffering this complication the risk for a fatal outcome is substantial.

Safety of a new algorithm for the management of childhood illness (Almanach) to improve quality of care and rational use of drugs

Introduction New evidence from randomized controlled and etiology of fever studies, the availability of reliable RDT for malaria, and novel technologies call for revision of the IMCI strategy. We developed a new algorithm based on (i) a systematic review of published studies assessing the safety and appropriateness of RDT and antibiotic prescription, (ii) results from a clinical and microbiological investigation of febrile children aged <5 years, (iii) international expert IMCI opinions. The aim of this study was to assess the safety of the new algorithm among patients in urban and rural areas of Tanzania.Materials and Methods The design was a controlled noninferiority study. Enrolled children aged 2-59 months with any illness were managed either by a study clinician using the new Almanach algorithm (two intervention health facilities), or clinicians using standard practice, including RDT (two control HF). At day 7 and day 14, all patients were reassessed. Patients who were ill in between or not cured at day 14 were followed until recovery or death. Primary outcome was rate of complications, secondary outcome rate of antibiotic prescriptions.Results 1062 children were recruited. Main diagnoses were URTI 26%, pneumonia 19% and gastroenteritis (9.4%). 98% (531/541) were cured at D14 in the Almanach arm and 99.6% (519/521) in controls. Rate of secondary hospitalization was 0.2% in each. One death occurred in controls. None of the complications was due to withdrawal of antibiotics or antimalarials at day 0. Rate of antibiotic use was 19% in the Almanach arm and 84% in controls.Conclusion Evidence suggests that the new algorithm, primarily aimed at the rational use of drugs, is as safe as standard practice and leads to a drastic reduction of antibiotic use. The Almanach is currently being tested for clinician adherence to proposed procedures when used on paper or a mobile phone

New directions in Stochastic Multicriteria Acceptability Analysis

Decisions taken in modern organizations are often multi-dimensional, involving multiple decision makers and several criteria measured on different scales. Multiple Criteria Decision Making (MCDM) methods are designed to analyze and to give recommendations in this kind of situations. Among the numerous MCDM methods, two large families of methods are the multi-attribute utility theory based methods and the outranking methods. Traditionally both method families require exact values for technical parameters and criteria measurements, as well as for preferences expressed as weights. Often it is hard, if not impossible, to obtain exact values. Stochastic Multicriteria Acceptability Analysis (SMAA) is a family of methods designed to help in this type of situations where exact values are not available. Different variants of SMAA allow handling all types of MCDM problems. They support defining the model through uncertain, imprecise, or completely missing values. The methods are based on simulation that is applied to obtain descriptive indices characterizing the problem. In this thesis we present new advances in the SMAA methodology. We present and analyze algorithms for the SMAA-2 method and its extension to handle ordinal preferences. We then present an application of SMAA-2 to an area where MCDM models have not been applied before: planning elevator groups for high-rise buildings. Following this, we introduce two new methods to the family: SMAA-TRI that extends ELECTRE TRI for sorting problems with uncertain parameter values, and SMAA-III that extends ELECTRE III in a similar way. An efficient software implementing these two methods has been developed in conjunction with this work, and is briefly presented in this thesis. The thesis is closed with a comprehensive survey of SMAA methodology including a definition of a unified framework.

Genetic algorithm for sequencing in midex model non-permutation flowshops using constrained buffers

Este trabajo presenta un Algoritmo Genético (GA) del problema de secuenciar unidades en una línea de producción. Se tiene en cuenta la posibilidad de cambiar la secuencia de piezas mediante estaciones con acceso a un almacén intermedio o centralizado. El acceso al almacén además está restringido, debido al tamaño de las piezas.AbstractThis paper presents a Genetic Algorithm (GA) for the problem of sequencing in a mixed model non-permutation flowshop. Resequencingis permitted where stations have access to intermittent or centralized resequencing buffers. The access to a buffer is restricted by the number of available buffer places and the physical size of the products.

Jatkuvavaletun teräksen leikkaussuunnitelman optimointi

Teollisuuden tuotannon eri prosessien optimointi on hyvin ajankohtainen aihe. Monet ohjausjärjestelmät ovat ajalta, jolloin tietokoneiden laskentateho oli hyvin vaatimaton nykyisiin verrattuna. Työssä esitetään tuotantoprosessi, joka sisältää teräksen leikkaussuunnitelman muodostamisongelman. Valuprosessi on yksi teräksen valmistuksen välivaiheita. Siinä sopivaan laatuun saatettu sula teräs valetaan linjastoon, jossa se jähmettyy ja leikataan aihioiksi. Myöhemmissä vaiheissa teräsaihioista muokataan pienempiä kokonaisuuksia, tehtaan lopputuotteita. Jatkuvavaletut aihiot voidaan leikata tilauskannasta riippuen monella eri tavalla. Tätä varten tarvitaan leikkaussuunnitelma, jonka muodostamiseksi on ratkaistava sekalukuoptimointiongelma. Sekalukuoptimointiongelmat ovat optimoinnin haastavin muoto. Niitä on tutkittu yksinkertaisempiin optimointiongelmiin nähden vähän. Nykyisten tietokoneiden laskentateho on kuitenkin mahdollistanut raskaampien ja monimutkaisempien optimointialgoritmien käytön ja kehittämisen. Työssä on käytetty ja esitetty eräs stokastisen optimoinnin menetelmä, differentiaalievoluutioalgoritmi. Tässä työssä esitetään teräksen leikkausoptimointialgoritmi. Kehitetty optimointimenetelmä toimii dynaamisesti tehdasympäristössä käyttäjien määrittelemien parametrien mukaisesti. Työ on osa Syncron Tech Oy:n Ovako Bar Oy Ab:lle toimittamaa ohjausjärjestelmää.

Coifman-aallokkeet ja skaalaussuotimen muodostus differentiaalievoluut ion avulla

Ortogonaalisen M-kaistaisen moniresoluutioanalyysin matemaattiset perusteet esitetään yksityiskohtaisesti. Coifman-aallokkeiden määritelmä yleistetään dilaatiokertoimelle M ja nollasta poikkeavalle häviävien momenttien keskukselle.Funktion approksimointia näytepisteistä aallokkeiden avulla pohditaan ja erityisesti esitetään approksimaation asymptoottinen virhearvio Coifman-aallokkeille. Skaalaussuotimelle osoitetaan välttämättömät ja riittävät ehdot, jotka johtavat yleistettyihin Coifman-aallokkeisiin. Moniresoluutioanalyysin tiheys todistetaansuoraan Lebesguen integraalin määritelmään perustuen yksikön partitio-ominaisuutta käyttäen. Todistus on riittävä sellaisenaan avaruudessa L2(Wd) käyttämättä Fourier-tason ominaisuuksia tai ehtoja. Mallatin algoritmi johdetaan M-kaistaisille aallokkeille ja moniuloitteisille signaaleille. Algoritmille esitetään myös rekursiivinen muoto. Differentiaalievoluutioalgoritmin avulla ratkaistaan Coifman-aallokkeisiin liittyvien skaalaussuotimien kertoimien arvoja useille skaalausfunktiolle. Approksimaatio- ja kuvanpakkausesimerkkejä esitetään menetelmien havainnollistamiseksi. Differentiaalievoluutioalgoritmin avulla etsitään myös referenssikuville optimoitu skaalaussuodin. Löydetty suodin on regulaarinen ja erittäinsymmetrinen.

Kumar's algorithm for solving Toeplitz systems of equations over finite fields

Adaptació de l'algorisme de Kumar per resoldre sistemes d'equacions amb matrius de Toeplitz sobre els reals a cossos finits en un temps 0 (n log n).

Implementation of the Rijndael-AES algorithm on a Sage-Math worksheet

La principal motivació d'aquest treball ha estat implementar l'algoritme Rijndael-AES en un full Sage-math, paquet de software matemàtic de lliure distribució i en actual desenvolupament, aprofitant les seves eines i funcionalitats integrades.

Reliability of the density functional approximation to describe the charge transfer and electrostatic complexes involved in the modeling of organic conducting polymers

Both the intermolecular interaction energies and the geometries for M ̄ thiophene, M ̄ pyrrole, M n+ ̄ thiophene, and M n+ ̄ pyrrole ͑with M = Li, Na, K, Ca, and Mg; and M n+ = Li+ , Na+ , K+ , Ca2+, and Mg2+͒ have been estimated using four commonly used density functional theory ͑DFT͒ methods: B3LYP, B3PW91, PBE, and MPW1PW91. Results have been compared to those provided by HF, MP2, and MP4 conventional ab initio methods. The PBE and MPW1PW91 are the only DFT methods able to provide a reasonable description of the M ̄ complexes. Regarding M n+ ̄ ␲ complexes, the four DFT methods have been proven to be adequate in the prediction of these electrostatically stabilized systems, even though they tend to overestimate the interaction energies.

Using time and stochastic models for software reliability forecasting and analysis

Tämä työ luo katsauksen ajallisiin ja stokastisiin ohjelmien luotettavuus malleihin sekä tutkii muutamia malleja käytännössä. Työn teoriaosuus sisältää ohjelmien luotettavuuden kuvauksessa ja arvioinnissa käytetyt keskeiset määritelmät ja metriikan sekä varsinaiset mallien kuvaukset. Työssä esitellään kaksi ohjelmien luotettavuusryhmää. Ensimmäinen ryhmä ovat riskiin perustuvat mallit. Toinen ryhmä käsittää virheiden ”kylvöön” ja merkitsevyyteen perustuvat mallit. Työn empiirinen osa sisältää kokeiden kuvaukset ja tulokset. Kokeet suoritettiin käyttämällä kolmea ensimmäiseen ryhmään kuuluvaa mallia: Jelinski-Moranda mallia, ensimmäistä geometrista mallia sekä yksinkertaista eksponenttimallia. Kokeiden tarkoituksena oli tutkia, kuinka syötetyn datan distribuutio vaikuttaa mallien toimivuuteen sekä kuinka herkkiä mallit ovat syötetyn datan määrän muutoksille. Jelinski-Moranda malli osoittautui herkimmäksi distribuutiolle konvergaatio-ongelmien vuoksi, ensimmäinen geometrinen malli herkimmäksi datan määrän muutoksille.

Sherali-Adams Relaxations and Indistinguishability in Counting Logics

Two graphs with adjacency matrices $\mathbf{A}$ and $\mathbf{B}$ are isomorphic if there exists a permutation matrix $\mathbf{P}$ for which the identity $\mathbf{P}^{\mathrm{T}} \mathbf{A} \mathbf{P} = \mathbf{B}$ holds. Multiplying through by $\mathbf{P}$ and relaxing the permutation matrix to a doubly stochastic matrix leads to the linear programming relaxation known as fractional isomorphism. We show that the levels of the Sherali--Adams (SA) hierarchy of linear programming relaxations applied to fractional isomorphism interleave in power with the levels of a well-known color-refinement heuristic for graph isomorphism called the Weisfeiler--Lehman algorithm, or, equivalently, with the levels of indistinguishability in a logic with counting quantifiers and a bounded number of variables. This tight connection has quite striking consequences. For example, it follows immediately from a deep result of Grohe in the context of logics with counting quantifiers that a fixed number of levels of SA suffice to determine isomorphism of planar and minor-free graphs. We also offer applications in both finite model theory and polyhedral combinatorics. First, we show that certain properties of graphs, such as that of having a flow circulation of a prescribed value, are definable in the infinitary logic with counting with a bounded number of variables. Second, we exploit a lower bound construction due to Cai, Fürer, and Immerman in the context of counting logics to give simple explicit instances that show that the SA relaxations of the vertex-cover and cut polytopes do not reach their integer hulls for up to $\Omega(n)$ levels, where $n$ is the number of vertices in the graph.

Anticipating linear stochastic differential equations driven by a Lévy process

In this paper we study the existence of a unique solution for linear stochastic differential equations driven by a Lévy process, where the initial condition and the coefficients are random and not necessarily adapted to the underlying filtration. Towards this end, we extend the method based on Girsanov transformations on Wiener space and developped by Buckdahn [7] to the canonical Lévy space, which is introduced in [25].

INCLUDING RISK IN ECONOMIC FEASIBILITY ANALYSIS:A STOCHASTIC SIMULATION MODEL FOR BLUEBERRY INVESTMENT DECISIONS IN CHILE

ABSTRACT The traditional method of net present value (NPV) to analyze the economic profitability of an investment (based on a deterministic approach) does not adequately represent the implicit risk associated with different but correlated input variables. Using a stochastic simulation approach for evaluating the profitability of blueberry (Vaccinium corymbosum L.) production in Chile, the objective of this study is to illustrate the complexity of including risk in economic feasibility analysis when the project is subject to several but correlated risks. The results of the simulation analysis suggest that the non-inclusion of the intratemporal correlation between input variables underestimate the risk associated with investment decisions. The methodological contribution of this study illustrates the complexity of the interrelationships between uncertain variables and their impact on the convenience of carrying out this type of business in Chile. The steps for the analysis of economic viability were: First, adjusted probability distributions for stochastic input variables (SIV) were simulated and validated. Second, the random values of SIV were used to calculate random values of variables such as production, revenues, costs, depreciation, taxes and net cash flows. Third, the complete stochastic model was simulated with 10,000 iterations using random values for SIV. This result gave information to estimate the probability distributions of the stochastic output variables (SOV) such as the net present value, internal rate of return, value at risk, average cost of production, contribution margin and return on capital. Fourth, the complete stochastic model simulation results were used to analyze alternative scenarios and provide the results to decision makers in the form of probabilities, probability distributions, and for the SOV probabilistic forecasts. The main conclusion shown that this project is a profitable alternative investment in fruit trees in Chile.