Outcomes and cost effectiveness of treating type 2 diabetes with a nurse case manager following treatment algorithms versus primary care physicians

Background. Diabetes places a significant burden on the health care system. Reduction in blood glucose levels (HbA1c) reduces the risk of complications; however, little is known about the impact of disease management programs on medical costs for patients with diabetes. In 2001, economic costs associated with diabetes totaled $100 billion, and indirect costs totaled $54 billion. ^ Objective. To compare outcomes of nurse case management by treatment algorithms with conventional primary care for glycemic control and cardiovascular risk factors in type 2 diabetic patients in a low-income Mexican American community-based setting, and to compare the cost effectiveness of the two programs. Patient compliance was also assessed. ^ Research design and methods. An observational group-comparison to evaluate a treatment intervention for type 2 diabetes management was implemented at three out-patient health facilities in San Antonio, Texas. All eligible type 2 diabetic patients attending the clinics during 1994–1996 became part of the study. Data were obtained from the study database, medical records, hospital accounting, and pharmacy cost lists, and entered into a computerized database. Three groups were compared: a Community Clinic Nurse Case Manager (CC-TA) following treatment algorithms, a University Clinic Nurse Case Manager (UC-TA) following treatment algorithms, and Primary Care Physicians (PCP) following conventional care practices at a Family Practice Clinic. The algorithms provided a disease management model specifically for hyperglycemia, dyslipidemia, hypertension, and microalbuminuria that progressively moved the patient toward ideal goals through adjustments in medication, self-monitoring of blood glucose, meal planning, and reinforcement of diet and exercise. Cost effectiveness of hemoglobin AI, final endpoints was compared. ^ Results. There were 358 patients analyzed: 106 patients in CC-TA, 170 patients in UC-TA, and 82 patients in PCP groups. Change in hemoglobin A1c (HbA1c) was the primary outcome measured. HbA1c results were presented at baseline, 6 and 12 months for CC-TA (10.4%, 7.1%, 7.3%), UC-TA (10.5%, 7.1%, 7.2%), and PCP (10.0%, 8.5%, 8.7%). Mean patient compliance was 81%. Levels of cost effectiveness were significantly different between clinics. ^ Conclusion. Nurse case management with treatment algorithms significantly improved glycemic control in patients with type 2 diabetes, and was more cost effective. ^

A retrospective analysis of patients referred for tuberculosis testing at Parkland Hospital, Dallas, TX

Tuberculosis (TB) is an infectious disease of great public health importance, particularly to institutions that provide health care to large numbers of TB patients such as Parkland Hospital in Dallas, TX. The purpose of this retrospective chart review was to analyze differences in TB positive and TB negative patients to better understand whether or not there were variables that could be utilized to develop a predictive model for use in the emergency department to reduce the overall number of suspected TB patients being sent to respiratory isolation for TB testing. This study included patients who presented to the Parkland Hospital emergency department between November 2006 and December 2007 and were isolated and tested for TB. Outcome of TB was defined as a positive sputum AFB test or a positive M. tuberculosis culture result. Data were collected utilizing the UT Southwestern Medical Center computerized database OACIS and included demographic information, TB risk factors, physical symptoms, and clinical results. Only two variables were significantly (P<0.05) related to TB outcome: dyspnea (shortness of breath) (P<0.001) and abnormal x-ray (P<0.001). Marginally significant variables included hemoptysis (P=0.06), weight loss (P=0.11), night sweats (P=0.20), history of homelessness or incarceration (P=0.15), and history of positive skin PPD (P=0.19). Using a combination of significant and marginally significant variables, a predictive model was designed which demonstrated a specificity of 24% and a sensitivity of 70%. In conclusion, a predictive model for TB outcome based on patients who presented to the Parkland Hospital emergency department between November 2006 and December 2007 was unsuccessful given the limited number of variables that differed significantly between TB positive and TB negative patients. It is suggested that a future prospective cohort study should be implemented to collect data on TB positive and TB negative patients. It may be possible that a more thorough prospective collection of data may lead to clearer comparisons between TB positive and TB negative patients and ultimately to the design of a more sensitive predictive model for TB outcome. ^

Maximal exercise hemodynamics and risk of mortality in apparently healthy men and women

The use of exercise electrocardiography (ECG) to detect latent coronary heart disease (CHD) is discouraged in apparently healthy populations because of low sensitivity. These recommendations however, are based on the efficacy of evaluation of ischemia (ST segment changes) with little regard for other measures of cardiac function that are available during exertion. The purpose of this investigation was to determine the association of maximal exercise hemodynamic responses with risk of mortality due to all-causes, cardiovascular disease (CVD), and coronary heart disease (CHD) in apparently healthy individuals. Study participants were 20,387 men (mean age = 42.2 years) and 6,234 women (mean age = 41.9 years) patients of a preventive medicine center in Dallas, TX examined between 1971 and 1989. During an average of 8.1 years of follow-up, there were 348 deaths in men and 66 deaths in women. In men, age-adjusted all-cause death rates (per 10,000 person years) across quartiles of maximal systolic blood pressure (SBP) (low to high) were: 18.2, 16.2, 23.8, and 24.6 (p for trend $<$0.001). Corresponding rates for maximal heart rate were: 28.9, 15.9, 18.4, and 15.1 (p trend $<$0.001). After adjustment for confounding variables including age, resting systolic pressure, serum cholesterol and glucose, body mass index, smoking status, physical fitness and family history of CVD, risks (and 95% confidence interval (CI)) of all-cause mortality for quartiles of maximal SBP, relative to the lowest quartile, were: 0.96 (0.70-1.33), 1.36 (1.01-1.85), and 1.37 (0.98-1.92) for quartiles 2-4 respectively. Similar risks for maximal heart rate were: 0.61 (0.44-0.85), 0.69 (0.51-0.93), and 0.60 (0.41-0.87). No associations were noted between maximal exercise rate-pressure product mortality. Similar results were seen for risk of CVD and CHD death. In women, similar trends in age-adjusted all-cause and CVD death rates across maximal SBP and heart rate categories were observed. Sensitivity of the exercise test in predicting mortality was enhanced when ECG results were evaluated together with maximal exercise SBP or heart rate with a concomitant decrease in specificity. Positive predictive values were not improved. The efficacy of the exercise test in predicting mortality in apparently healthy men and women was not enhanced by using maximal exercise hemodynamic responses. These results suggest that an exaggerated systolic blood pressure or an attenuated heart rate response to maximal exercise are risk factors for mortality in apparently healthy individuals. ^

THE DISCHARGED PSYCHIATRIC PATIENT: POST-HOSPITAL ADJUSTMENT AND FACTORS AFFECTING REHOSPITALIZATION

Discharged psychiatric patients were studied six months post-discharge to determine those demographic, social and clinical characteristics affecting positive or negative adjustment and the degree to which the use of mental health services and medication compliance mediated the effects. With the exception of those with primary or secondary diagnoses of OBS, substance abuse or mental retardation, sixty-three psychiatric subjects between the ages of eighteen and sixty-four were chosen from all admissions into the hospital and interviewed six months after discharge using a specially designed questionnaire.^ The subjects' adjustment to community living was found to be marginal. Although not engaged in destructive activities, over half were living with their family members who supported them financially and emotionally. Most were unemployed and had been so for a long time. Others worked sporadically and frequently changed residences. Most did have substantial social ties with extended family and with friends with whom they interacted regularly, but one-fourth were socially isolated. Almost three-quarters continued to obtain regular mental health services after discharge and followed medication instructions under the supervision of their physician. The use of mental health services after discharge and the use of medication did not appear to affect the subjects' community adaption or their rate of rehospitalization.^ Forty percent of those discharged were rehospitalized by the end of the follow-up period. Four levels of risk of rehospitalization emerged. The highest risk was associated with a history of five or more prior hospitalizations, living alone, and social isolation. One third or more of the subjects expressed a need for more counseling, leisure time activities, case-manager assistance, vocational guidance, supervised housing, and placement into a transitional residential treatment program.^ Recommendations were made to enhance the ability to predict recidivism, to develop interorganizational casework management programs linking the patient and family to the community mental health system and to create computerized tracking and monitoring programs that systematically report patient treatment regimen and progress cross-sectionally and longitudinally. ^

The incidence of necrotizing changes in adults with pneumococcal pneumonia

Background. Necrotizing pneumonia is generally considered a rare complication of pneumococcal pneumonia in adults. We systematically studied the incidence of necrotizing changes in adult patients with pneumococcal pneumonia, and examined the severity of infection, the role of causative serotype and the association with bacteremia. ^ Methods. We used a data base of all pneumococcal infections identified at our medical center between 2000 and 2010. Original readings of chest X-rays (CXR) and computerized tomography (CT) were noted. All images were then reread independently by 2 radiologists. The severity of disease was assessed using the SMART-COP scoring system. ^ Results. There were 351 cases of pneumococcal pneumonia. Necrosis was reported in no original CXR readings and 6 of 136 (4.4%) CTs. With re-reading, 8 of 351 (2.3%) CXR and 15 of 136 (11.0%) CT had necrotizing changes. Overall, these changes were found in 23 of 351 (6.6%, 95% CI 4.0 - 9.1) patients. The incidence of bacteremia and the admitting SMART-COP scores were similar in patients with and without necrosis (P=1.00 and P=0.32, respectively). Type 3 pneumococcus was more commonly isolated from patients with than from patients without necrotizing pneumonia (P=0.05), but a total of 10 serotypes were identified among 16 cases in which the organism was available for typing. ^ Conclusions. Necrotizing changes in the lungs were seen in 6.6% (95% CI 4.0 - 9.1) of a large series of adults with pneumococcal pneumonia. Patients with necrosis were not more likely to have bacteremia or more severe disease. Type 3 pneumococcus was commonly implicated, but 9 other serotypes were also identified.^

Non-nutritive sucking and the preterm infant

Background. Preterm birth is major public health problem. Preterm infants face a post-natal environment that their under developed systems are inapt to manage. Developmentally supportive individualized care has demonstrated positive outcomes in minimizing resulting negative effects. Non-nutritive sucking (NNS) interventions are thought to promote the development of the suck-swallow-breathe mechanism and a calming tool. It is hypothesized that growth and development is maintained by strengthened sucking skills and stable behavioral states.^ Objective. To determine the importance of non-nutritive sucking (NNS) on outcomes that are clinically relevant to the preterm infant population.^ Methods. A computerized search of MEDLINE and PUBMED databases during the period of 1975 and May 2011 was conducted. Relevant articles were selected using published criteria for detecting clinically validated studies. The search yielded 10 randomized controlled studies relative to the outcomes of interest: weight gain, time to full feeds, time to discharge from hospital, and pain response.^ Results. NNS was found to decrease significantly the length of hospitalization in preterm infants. Although positive results were reported in some of the studies, the results did not show a consistent benefit of NNS with respect to other major clinical variables. NNS was shown to reduce distress following painful stimuli.^ Conclusion. Although NNS shows promise for the development of preterm infants, there is lack of agreement concerning some of the outcomes of interest. Evidence does support NNS's positive contribution to early hospital discharge and pain relief. Future research should focus on long-term, comparable outcomes. ^

Exposure to nonsteroidal anti-inflammatory drugs and weight loss and hospitalization in non-small cell lung cancer patients

Background. Cancer cachexia is a common syndrome complex in cancer, occurring in nearly 80% of patients with advanced cancer and responsible for at least 20% of all cancer deaths. Cachexia is due to increased resting energy expenditure, increased production of inflammatory mediators, and changes in lipid and protein metabolism. Non-steroidal anti-inflammatory drugs (NSAIDs), by virtue of their anti-inflammatory properties, are possibly protective against cancer-related cachexia. Since cachexia is also associated with increased hospitalizations, this outcome may also show improvement with NSAID exposure. ^ Design. In this retrospective study, computerized records from 700 non-small cell lung cancer patients (NSCLC) were reviewed, and 487 (69.57%) were included in the final analyses. Exclusion criteria were severe chronic obstructive pulmonary disease, significant peripheral edema, class III or IV congestive heart failure, liver failure, other reasons for weight loss, or use of research or anabolic medications. Information on medication history, body weight and hospitalizations was collected from one year pre-diagnosis until three years post-diagnosis. Exposure to NSAIDs was defined if a patient had a history of being treated with NSAIDs for at least 50% of any given year in the observation period. We used t-test and chi-square tests for statistical analyses. ^ Results. Neither the proportion of patients with cachexia (p=0.27) nor the number of hospitalizations (p=0.74) differed among those with a history of NSAID use (n=92) and those without (n=395). ^ Conclusions. In this study, NSAID exposure was not significantly associated with weight loss or hospital admissions in patients with NSCLC. Further studies may be needed to confirm these observations.^

(Table 1) Morphometrics of narwhal (Monodon monoceros) fluke planforms

In this study, we compared the fluke geometries of male and female narwhals, which may be associated with hydrodynamic effects. Computerized tomography (CT) scanning was used to obtain data for analyses of the three-dimensional geometry of the flukes. The flukes from four narwhals (two males and two females) were obtained from aboriginal hunters in the vicinity of Broughton Island, Canada. The body lengths of the animals ranged from 2.98 to 3.60 m. Both males had erupted, upper left tusks. Standard body measurements were made including the span of the fluke (i.e., linear distance between fluke tips).

Hydrocarbon concentrations from pressurized cores in the northern Gulf of Mexico

Two newly developed coring devices, the Multi-Autoclave-Corer and the Dynamic Autoclave Piston Corer were deployed in shallow gas hydrate-bearing sediments in the northern Gulf of Mexico during research cruise SO174 (Oct-Nov 2003). For the first time, they enable the retrieval of near-surface sediment cores under ambient pressure. This enables the determination of in situ methane concentrations and amounts of gas hydrate in sediment depths where bottom water temperature and pressure changes most strongly influence gas/hydrate relationships. At seep sites of GC185 (Bush Hill) and the newly discovered sites at GC415, we determined the volume of low-weight hydrocarbons (C1 through C5) from nine pressurized cores via controlled degassing. The resulting in situ methane concentrations vary by two orders of magnitudes between 0.031 and 0.985 mol kg**-1 pore water below the zone of sulfate depletion. This includes dissolved, free, and hydrate-bound CH4. Combined with results from conventional cores, this establishes a variability of methane concentrations in close proximity to seep sites of five orders of magnitude. In total four out of nine pressure cores had CH4 concentrations above equilibrium with gas hydrates. Two of them contain gas hydrate volumes of 15% (GC185) and 18% (GC415) of pore space. The measurements prove that the highest methane concentrations are not necessarily related to the highest advection rates. Brine advection inhibits gas hydrate stability a few centimeters below the sediment surface at the depth of anaerobic oxidation of methane and thus inhibits the storage of enhanced methane volumes. Here, computerized tomography (CT) of the pressure cores detected small amounts of free gas. This finding has major implications for methane distribution, possible consumption, and escape into the bottom water in fluid flow systems related to halokinesis.

Mineralogical and stable isotope analyses of carbonates from the eastern Black Sea

Authigenic carbonates associated with cold seeps provide valuable archives of changes in the long-term seepage activity. To investigate the role of shallow-buried hydrates on the seepage strength and fluid composition we analysed methane-derived carbonate precipitates from a high-flux hydrocarbon seepage area ("Batumi seep area") located on the south-eastern Black Sea slope in ca. 850 m. In a novel approach, we combined computerized X-ray tomography (CT) with mineralogical and isotope geochemical methods to get additional insights into the three-dimensional internal structure of the carbonate build-ups. X-ray diffractometry revealed the presence of two different authigenic carbonate phases, i.e. pure aragonitic rims associated with vital microbial mats and high-Mg calcite cementing the hemipelagic sediment. As indicated by the CT images, the initial sediment has been strongly deformed, first plastic then brittle, leading to brecciation of the progressively cemented sediment. The aragonitic rims on the other hand, represent a presumably recent carbonate growth phase since they cover the already deformed sediment. The stable oxygen isotope signature indicates that the high-Mg calcite cement incorporated pore water mixed with substantial hydrate water amounts. This points at a dominant role of high gas/fluid flux from decomposing gas hydrates leading to the deformation and cementation of the overlying sediment. In contrast, the aragonitic rims do not show an influence of 18O-enriched hydrate water. The differences in d18O between the presumably recent aragonite precipitates and the older high-Mg cements suggest that periods of hydrate dissociation and vigorous fluid discharge alternated with times of hydrate stability and moderate fluid flow. These results indicate that shallow-buried gas hydrates are prone to episodic decomposition with associated vigorous fluid flow. This might have a profound impact on the seafloor morphology resulting e.g. in the formation of carbonate pavements and pockmark-like structures but might also affect the local carbon cycle.

Database on the molluscan fauna from the Mediterranean Reef Ecosystems (CorMolDB - Part I)

In the Mediterranean Sea, infralittoral and circalittoral rocky bottoms (from 15 to 120 m) are characterized by a biogenic habitat, named "coralligenous", formed by the concretion of calcareous organisms, mainly algal thalli, and- to a lesser extent- by animal skeletons. This complex habitat is inhabited by a rich fauna that belongs to different taxonomic groups. Sponges, bryozoans, cnidarians and ascidians are the most common sessile organisms that inhabit the area while crustacean and molluscs are the common mobile organisms. Little information on the diversity of the molluscs that thrive in the coralligenous habitat is known while this information is highly important for biodiversity management purposes. After thoroughly studying the available and accessible published literature, a database for the molluscs of the coralligenous habitat has been designed and implemented for the collection and management of this information. From its index compilation more than 511 species of molluscs have been recorded so far from the coralligenous formations, the majority of which belongs to the class Gastropoda (357 sp.) followed by the Bivalvia (137 sp.), Polyplacophora (14 sp.), Cephalopoda (2 sp.) and Scaphopoda (1 sp.). Among these, the gastropod Luria lurida (Linnaeus, 1758) and Charonia lampas (Linnaeus, 1758), the endemic bivalve Pinna nobilis Linnaeus, 1758 and the endolithic bivalve Lithophaga lithophaga (Linnaeus, 1758), are protected by international conventions.

Contribución a las nuevas tendencias en el diseño de tuberías en construcción naval

En la situación actual, tanto las posibilidades de contratar como los resultados económicos de un astillero, dependen de su capacidad para construir un buque en el plazo mas corto posible. Dentro de los trabajos de diseño y construcción de de un buque el trabajo de tuberías ha sido el que tradicionalmente ha condicionado los plazos de construcción. En este estudio se considerara que se han tenido en cuenta los criterios necesarios para que las instalaciones del buque funcionen correctamente y se verá como los sistemas de diseño influyen en el coste y plazo del buque y, por tanto, en la productividad del astillero. Se estudian los distintos procesos de diseño, fabricación y montaje de tuberías, la evolución de estos procesos a lo largo del tiempo, los módulos de armamento que se realizan en los astilleros, los modelos de cámara de máquinas, y los sistemas de ayuda al diseño por ordenador. El autor, en su puesto de Jefe de la Oficina Tecnológica de la Factoría de Sevilla de Astilleros Españoles en los últimos 12 años, ha tomado parte activa en esta evolución, formando parte de un equipo que ha situado a este astillero entre los mas avanzarlos de Europa. Todo lo anterior sirve de base para la segunda parte de este estudio, donde se abordan las que, en opinión del autor, son las nuevas tendencias en el diseño de tuberías en la construcción naval. V Integración del CAD/CAM o CIM : CAD = computer aided design o diseño asistido por ordenador, CAM = computer aided manufacturing o fabricación asistida por ordenador, CIM = computer integrated manufacturing o fabricación integrada por ordenador. Se estudia la integración de los procesos de diseño con el resto de los procesos de gestión y de producción de un astillero, proponiéndose un modelo de cómo el autor ve esta integración. Se comenta la actual tendencia a pasar de las automatizaciones duras con maquinas especializadas para cada proceso, a las automatizaciones blandas en las que un robot puede realizar distintos procesos modificando su programación. Se estudian las nuevas posibilidades de la normal i zacio'n, de los planos parametrizados y de la tecnología de grupos aportando algunos ejemplos. Se estudia también como los procesos anteriores conducirán a una optimización del producto en sí, es decir a conseguir mejores buques. En las conclusiones destacamos como el camino que tienen los países desarrollados, como el nuestro, para mantener una industria competitiva de construcción naval va por la mecanización de los procesos constructivos siguiendo las tendencias anteriores y obteniendo buques optimizados. vi SUMMARY Under the present situation the possibilities to contract and the economical results of a Shipyard depend on its capacity to build a ship within the shortest time. i Within the works of design and construction of a ship, piping work has traditionally conditioned the construction time. In this study it shall be considered that the necessary criteria for the ship installations to operate correctly have been taken into account and it shall be noticed how the design systems influence on the cost and time of a ship and therefore on the Shipyard's productivity. Studies are made of different design processes, manufacturing and installation of piping, evolution of these processes along the time, outfitting modules made in the Shipyard, engine room models and computerized design aid systems. The author, in his post of Chief of the Technological Office of Sevilla Shipyard of Astilleros Españoles for the last 12 years, has taken an active part in this evolution, making part of a team which has placed this Shipyard among the most advanced in Europe. All of the above is used for the second part of this study, whereby an approach is made to those who, in the author's opinion, are the new trends in the piping design of shipbuilding. vii Integration of CAD/CAM or CIM: CAD = computer aided design, CAM = computer aided manufacturing, CIM = computer integrated manufacturing. i A study is made of the integration of design processes with the remaining step and production Shipyard processes, proposing a model of how the author views this integration. Comments are made on the present trend to go from hard automations with specialized machines for each process to soft automations, in which a robot can carry out different processes modifying its programmes. Studies are made of: New possibility of standardization, parametrized drawings and group technology, bringing some examples. It is also studied how the above processes shall lead to optimize the product itself, that is, to obtain better ships. In the conclusions we stand out how the way of developed countries (as ours) to maintain a competitive shipbuilding industry is by computerizing constructive processes, following the above trends and obtaining better ships.

Estudio y desarrollo de un preproceso basado en la difusión no lineal para la segmentación en imágenes

En esta Tesis Doctoral se aborda la utilización de filtros de difusión no lineal para obtener imágenes constantes a trozos como paso previo al proceso de segmentación. En una primera parte se propone un formulación intrínseca para la ecuación de difusión no lineal que proporcione las condiciones de diseño necesarias sobre los filtros de difusión. A partir del marco teórico propuesto, se proporciona una nueva familia de difusividades; éstas son obtenidas a partir de técnicas de difusión no lineal relacionadas con los procesos de difusión regresivos. El objetivo es descomponer la imagen en regiones cerradas que sean homogéneas en sus niveles de grises sin contornos difusos. Asimismo, se prueba que la función de difusividad propuesta satisface las condiciones de un correcto planteamiento semi-discreto. Esto muestra que mediante el esquema semi-implícito habitualmente utilizado, realmente se hace un proceso de difusión no lineal directa, en lugar de difusión inversa, conectando con proceso de preservación de bordes. Bajo estas condiciones establecidas, se plantea un criterio de parada para el proceso de difusión, para obtener imágenes constantes a trozos con un bajo coste computacional. Una vez aplicado todo el proceso al caso unidimensional, se extienden los resultados teóricos, al caso de imágenes en 2D y 3D. Para el caso en 3D, se detalla el esquema numérico para el problema evolutivo no lineal, con condiciones de contorno Neumann homogéneas. Finalmente, se prueba el filtro propuesto para imágenes reales en 2D y 3D y se ilustran los resultados de la difusividad propuesta como método para obtener imágenes constantes a trozos. En el caso de imágenes 3D, se aborda la problemática del proceso previo a la segmentación del hígado, mediante imágenes reales provenientes de Tomografías Axiales Computarizadas (TAC). En ese caso, se obtienen resultados sobre la estimación de los parámetros de la función de difusividad propuesta. This Ph.D. Thesis deals with the case of using nonlinear diffusion filters to obtain piecewise constant images as a previous process for segmentation techniques. I have first shown an intrinsic formulation for the nonlinear diffusion equation to provide some design conditions on the diffusion filters. According to this theoretical framework, I have proposed a new family of diffusivities; they are obtained from nonlinear diffusion techniques and are related with backward diffusion. Their goal is to split the image in closed contours with a homogenized grey intensity inside and with no blurred edges. It has also proved that the proposed filters satisfy the well-posedness semi-discrete and full discrete scale-space requirements. This shows that by using semi-implicit schemes, a forward nonlinear diffusion equation is solved, instead of a backward nonlinear diffusion equation, connecting with an edgepreserving process. Under the conditions established for the diffusivity and using a stopping criterion I for the diffusion time, I have obtained piecewise constant images with a low computational effort. The whole process in the one-dimensional case is extended to the case where 2D and 3D theoretical results are applied to real images. For 3D, develops in detail the numerical scheme for nonlinear evolutionary problem with homogeneous Neumann boundary conditions. Finally, I have tested the proposed filter with real images for 2D and 3D and I have illustrated the effects of the proposed diffusivity function as a method to get piecewise constant images. For 3D I have developed a preprocess for liver segmentation with real images from CT (Computerized Tomography). In this case, I have obtained results on the estimation of the parameters of the given diffusivity function.

Cinemómetro piezoeléctrico de alta exactitud (VUAE)

Se ha desarrollado un sistema electrónico computerizado, portátil y de bajo consumo, denominado Medidor de Velocidad de Vehículos por Ultrasonidos de Alta Exactitud, VUAE. La alta exactitud de la medida conseguida en el VUAE hace que pueda servir de medida de referencia de la velocidad de un vehículo circulando en carretera. Por tanto el VUAE puede usarse como medida de referencia que permita estimar el error de los cinemómetros comerciales. El VUAE está compuesto por n (n≥2) parejas de emisores y receptores piezoeléctricos de ultrasonidos, denominados E-Rult. Los emisores de las n parejas E-Rult generan n barreras de ultrasonidos, y los receptores piezoeléctricos captan la señal de los ecos cuando el vehículo atraviesa las barreras. Estos ecos se procesan digitalmente para conseguir señales representativas. Posteriormente, utilizando la técnica de la correlación cruzada de señales, se ha podido estimar con alta exactitud la diferencia de tiempos entre los ecos captados en cada barrera. Con los tiempos entre ecos y con la distancia entre cada una de las n barreras de ultrasonidos se puede realizar una estimación de la velocidad del vehículo con alta exactitud. El VUAE se ha contrastado con un sistema de velocidad de referencia, basado en cables piezoeléctricos. ABSTRACT We have developed a portable computerized and low consumption, our system is called High Accuracy Piezoelectric Kinemometer measurement, herein VUAE. By the high accuracy obtained by VUAE it make able to use the VUAE to obtain references measurements of system for measuring Speeds in Vehicles. Therefore VUAE could be used how reference equipment to estimate the error of installed kinemometers. The VUAE was created with n (n≥2) pairs of ultrasonic transmitter-receiver, herein E-Rult. The transmitters used in the n couples E-Rult generate n ultrasonic barriers and receivers receive the echoes when the vehicle crosses the barriers. Digital processing of the echoes signals let us to obtain acceptable signals. Later, by mean of cross correlation technics is possible make a highly exact estimation of speed of the vehicle. The log of the moments of interception and the distance between each of the n ultrasounds allows for a highly exact estimation of speed of the vehicle. VUAE speed measurements were compared to a speed reference system based on piezoelectric cables.

Desarrollo y caracterización de un material celular de alta porosidad con base cementicia activada mediante agentes inorgánicos

Esta tesis ha estudiado los morteros celulares, centrándose en la experimentación con pastas de cemento aireadas (PCA) con polvo de aluminio como agente expansor. El objetivo es el desarrollo de un material cementicio con una baja conductividad térmica que sirva como aislamiento térmico. La naturaleza inorgánica del material lo hace incombustible, en contraste con las espumas poliméricas existentes en el mercado, cuya aplicación en cámaras ventiladas ha sido prohibida por normativas de construcción tanto a nivel nacional como internacional. Las posibles aplicaciones son con proyección neumática o en paneles prefabricados. Se han ensayado dos series de pastas de cemento con polvo de aluminio: - Serie WPC/CAC/CH. Mezcla de referencia con cemento blanco (WPC), cemento de aluminato cálcico (CAC) y cal aérea (CH) en proporción 5:1:4. - Serie OPC/CH. Mezcla de referencia con cemento portland con cenizas volantes (OPC) y cal aérea (CH) en proporción OPC/CH de 4:1 A las mezclas de referencia se le han añadido adiciones de metacaolín (MK) (10 y 20%) o sepiolita (SP) (1 y 2%) para observar el efecto que producen tanto en el mortero fresco como en el mortero endurecido. Se ha estudiado la reología de las pastas en estado fresco, analizando el proceso de expansión de las pastas, registrando los valores de tensión de fluencia, aire ocluido y temperatura durante la expansión. Con los valores obtenidos se ha discutido la influencia de las adiciones utilizadas en la cinética de corrosión del polvo de aluminio que genera la expansión, concluyendo que las adiciones puzolánicas (CV y MK) y la SP reducen mucho el periodo de inducción, lo que provoca poros más grandes y mayor cantidad de aire ocluido. Asimismo se ha analizado la relación entre la tensión de fluencia y el contenido de aire ocluido, deduciendo que a mayor tensión de fluencia en el momento de iniciarse la expansión, menor tamaño de poros y contenido de aire ocluido. Finalmente, se han obtenido las densidades y capacidades de retención de agua de los morteros frescos. Para caracterizar la red porosa de las pastas aireadas endurecidas, se obtuvieron tanto las densidades reales, netas, aparentes y relativas como las porosidades abiertas, cerradas y totales con ensayos hídricos. Finalmente se obtuvieron imágenes de los poros con tomografía axial computerizada para obtener las porosimetrías de las muestras. La caracterización de la red porosa ha servido para terminar de analizar lo observado en la evolución de la expansión del mortero fresco. Se ha analizado la influencia de la red porosa en la conductividad térmica, obtenida con caja caliente, comparándola con la existente en la literatura existente tanto de morteros celulares como de espumas poliméricas. Se concluye que los valores de conductividad térmica conseguida están en el mínimo posible para un material celular de base cementicia. La microestructura se ha estudiado con microscopía electrónica de barrido, difracción de rayos X y ensayos térmicos TG/ATD, observando que los productos de hidratación encontrados coinciden con los que se producen en morteros sin airear. Las imágenes SEM y los resultados de ultrasonidos han servido para analizar la presencia de microfisuras de retracción en las pastas aireadas, observando que en las muestras con adiciones de MK y SP, se reduce la presencia de microfisuras. ABSTRACT This thesis has studied cellular mortars, focusing in testing aerated cement pastes with aluminum powder as expansive agent. The purpose is the development of a cementitious material with low thermal conductivity that can be used as thermal isolation. Inorganic nature of this material makes it non-combustible, in contrast with polymeric foams in market, whose application in ventilated double skin façade systems has been banned by building standards, both domestically and internationally. Possible uses for this material are pneumatically sprayed applications and precast panels. Two series of batches with aluminum powder have been tested: - WPC/CAC/CH series. Reference paste with white portland cement (WPC), calcium aluminate cement (CAC) and lime (CH) with 5:1:4 ratio. - OPC/CH series. Reference paste with portland cement with fly ash (OPC) and lime (CH) with 4:1 ratio. Metakaolin (MK) (10 and 20%) or sepiolite (SP) (1 and 2%) additions were used in reference pastes to characterize the effect in fresh and hardened mortar. Rheology in fresh pastes was studied, expansion process of pastes was analyzed, recording yield stress, entrained air and temperature values during expansion. Recorded values were used to discuss influence of additions on reaction kinetics of aluminum powder corrosion, that produces expansion.. Conclusion is that pozzolanic additions (FA and MK) and SP greatly reduce induction period, producing bigger pores and more entrained air. Relation between yield stress and entrained air has been also analyzed, observing that the bigger yield stress at beginning of expansion, the smaller pores size and the lower entrained air values. Finally density and water retention of fresh mortars were obtained. Pore network in hardened aerated cement pastes was characterized by imbibition methods providing true, bulk and relative density, and providing also open, closed and total porosity. Finally, pore system imaging were obtained with computerized axial tomography to study porosimetry of specimens. Pore network characterization was useful to complete facts analysis observed in expansion of fresh mortars. Influence of pore network in thermal conductivity, checked in hot box, was analyzed comparing with those existing values in cellular mortar and polymeric foams researches. It was concluded that thermal conductivity values achieved are close to minimum possible in a cementitious cellular material. Microstructure was studied with Scanning Electron Microscopy, X-Ray Diffractometry and TG-DTA analysis, observing that hydration phases found, are those produced in non aerated mortar. SEM imaging and ultrasound results were useful to analyze shrinkage microcracks in aerated cement pastes, concluding that microcrack presence in specimens with MK and SP additions were reduced.