Orlando furioso:

"The life of Ariosto: extracted from Pigna, Fornari, Garafolo Mazzuchelli, and others": v. 1, p. [xlix]-cii.

Development of a dosage strategy in patients receiving enoxaparin by continuous intravenous infusion using modelling and simulation

Aim To develop an appropriate dosing strategy for continuous intravenous infusions (CII) of enoxaparin by minimizing the percentage of steady-state anti-Xa concentration (C-ss) outside the therapeutic range of 0.5-1.2 IU ml(-1). Methods A nonlinear mixed effects model was developed with NONMEM (R) for 48 adult patients who received CII of enoxaparin with infusion durations that ranged from 8 to 894 h at rates between 100 and 1600 IU h(-1). Three hundred and sixty-three anti-Xa concentration measurements were available from patients who received CII. These were combined with 309 anti-Xa concentrations from 35 patients who received subcutaneous enoxaparin. The effects of age, body size, height, sex, creatinine clearance (CrCL) and patient location [intensive care unit (ICU) or general medical unit] on pharmacokinetic (PK) parameters were evaluated. Monte Carlo simulations were used to (i) evaluate covariate effects on C-ss and (ii) compare the impact of different infusion rates on predicted C-ss. The best dose was selected based on the highest probability that the C-ss achieved would lie within the therapeutic range. Results A two-compartment linear model with additive and proportional residual error for general medical unit patients and only a proportional error for patients in ICU provided the best description of the data. Both CrCL and weight were found to affect significantly clearance and volume of distribution of the central compartment, respectively. Simulations suggested that the best doses for patients in the ICU setting were 50 IU kg(-1) per 12 h (4.2 IU kg(-1) h(-1)) if CrCL < 30 ml min(-1); 60 IU kg(-1) per 12 h (5.0 IU kg(-1) h(-1)) if CrCL was 30-50 ml min(-1); and 70 IU kg(-1) per 12 h (5.8 IU kg(-1) h(-1)) if CrCL > 50 ml min(-1). The best doses for patients in the general medical unit were 60 IU kg(-1) per 12 h (5.0 IU kg(-1) h(-1)) if CrCL < 30 ml min(-1); 70 IU kg(-1) per 12 h (5.8 IU kg(-1) h(-1)) if CrCL was 30-50 ml min(-1); and 100 IU kg(-1) per 12 h (8.3 IU kg(-1) h(-1)) if CrCL > 50 ml min(-1). These best doses were selected based on providing the lowest equal probability of either being above or below the therapeutic range and the highest probability that the C-ss achieved would lie within the therapeutic range. Conclusion The dose of enoxaparin should be individualized to the patients' renal function and weight. There is some evidence to support slightly lower doses of CII enoxaparin in patients in the ICU setting.

Application of Monte Carlo simulations to identify an appropriate dosage strategy for patients receiving a continuous intravenous infusion of enoxaparin

Aim: To identify an appropriate dosage strategy for patients receiving enoxaparin by continuous intravenous infusion (CII). Methods: Monte Carlo simulations were performed in NONMEM, (200 replicates of 1000 patients) to predict steady state anti-Xa concentrations (Css) for patients receiving a CII of enoxaparin. The covariate distribution model was simulated based on covariate demographics in the CII study population. The impact of patient weight, renal function (creatinine clearance (CrCL)) and patient location (intensive care unit (ICU)) were evaluated. A population pharmacokinetic model was used as the input-output model (1-compartment first order output model with mixed residual error structure). Success of a dosing regimen was based on the percent of Css that is between the therapeutic range of 0.5 IU/ml to 1.2 IU/ml. Results: The best dose for patients in the ICU was 4.2IU/kg/h (success mean 64.8% and 90% prediction interval (PI): 60.1–69.8%) if CrCL60ml/min, the best dose was 8.3IU/kg/h (success mean 65.4%, 90% PI: 58.5–73.2%). Simulations suggest that there was a 50% improvement in the success of the CII if the dose rate for ICU patients with CrCL

Challenges to improve inter-professional care and service collaboration for people living with psychiatric disabilities in ordinary housing

The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking backevaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.

Algoritmos de reconstrucción de superficies 3D para modelaje antropométrico

Los protocolos de medición antropométrica se caracterizan por la profusión de medidas discretas o localizadas, en un intento para caracterizar completamente la forma corporal del sujeto -- Dichos protocolos se utilizan intensivamente en campos como medicina deportiva, forense y/o reconstructiva, diseño de prótesis, ergonomía, en la confección de prendas, accesorios, etc -- Con el avance de algoritmos de recuperación de formas a partir de muestreos (digitalizaciones) la caracterización antropométrica se ha alterado significativamente -- El articulo presente muestra el proceso de caracterización digital de forma corpórea, incluyendo los protocolos de medición sobre el sujeto, el ambiente computacional - DigitLAB- (desarrollado en el CII-CAD-CAM-CG de la Universidad EAFIT) para recuperación de superficies, hasta los modelos geométricos finales -- Se presentan comparaciones de los resultados obtenidos con DigitLAB y con paquetes comerciales de recuperación de forma 3D -- Los resultados de DigitLAB resultan superiores, debido principalmente al hecho de que este toma ventaja de los patrones de las digitalizaciones (planares de contacto, por rejilla de pixels - range images -, etc.) y provee módulos de tratamiento geométrico - estadístico de los datos para poder aplicar efectivamente los algoritmos de recuperación de forma -- Se presenta un caso de estudio dirigido a la industria de la confección, y otros efectuados sobre conjuntos de prueba comunes en el ámbito científico para la homologación de algoritmos

AGENDA AMBIENTAL DEL AGUA EN COSTA RICA

La crisis de gobcrnabilidad de los recursos hídricos es clara y evidente en Costa Rica. Estos recursos están en proceso de deterioro y peligrosamente amenazados. En tan solo cinco décadas se pasó de la riqueza y abundancia de agua, a la vulnerabilidad y escasez de ésta. Un conjunto de realidades ha originado la mencionada crisis: la ausencia de políticas hídricas integrales, claras y estables, un marco legal desactualizado. estático y de mínimo cumplimiento, que ha permitido el uso ineficiente y la contaminación de los cuerpos de agua y desde luego la cultura dominante de poca o ninguna valoración del agua como recurso vital para el desarrollo presente y futuro de todas las especies que poblamos el país.La Agenda Ambiental del Agua en Costa Rica ha sido elaborada mediante un proceso parlicipativo. donde diversos actores sociales en diferentes regiones —Limón, Liberia y la Gran Area Metropolitana (GAM)— priorizaron los 10 principales problemas y sus potenciales soluciones:1) La educación formal e informal es muy débil respecto a como alcanzar el uso eficiente e inteligente de los recursos hrdricos. Igualmente, es débil para revertir el patrón de manejo de vertidos sin responsabilidad social.2) La excesiva centralización de las decisiones. Muy poca participación ciudadana tanto en la estructura organizativa como en la toma de decisiones.3) La inoperancia del marco institucional y legal —desconocimiento por parte de la sociedad civil de los procesos de denuncia y otros; la tramitología de denuncia es demasiado lenta e ineficiente, razón por la cual los denunciantes se cansan y desaniman—.4) La deficiente y casi nula valoración económica del agua, que tome en cuenta el manejo integral de las cuencas y la búsqueda de la permanencia del recurso en el futuro.5) La ausencia de planes hídricos de cuencas donde el plan regulador sea un componente básico.6) La desigual calidad del agua para los costarricenses según operador del servicio y región geográfica.7) La contaminación de aguas superficiales y subterráneas.8) La ausencia de conocimiento, socialización, sistematización y movilización en relación con el manejo del agua. Es necesario el aumento de las capacidades tanto técnicas y científicas como de cambio de cultura y conocimiento popular.9) Falta de información básica y mecanismos claros para poder utilizarla.10) La información existente en la actualidad se encuentra dispersa en diferentes orgarnza ciones y en algunos investigadores, lo que impide su uso efectivo.La Agenda Ambiental del Agua en Costa Rica aproxima los costos para la solución de los problemas apuntados anteriormente. Se necesita invertir alrededor de US$J .500 millones para abordar la gestión integrada de los recursos hídricos en el país.Abstract: The crisis of governance of thc watcr resources is clear and evideni in Costa Rica. These resources are in proccss oídeterioration anddangerously threatened. In only five decades it passed of che wealth and water abundance, to che vulnerability and shortagc of thc same one. A set of realities has originated dic mentioned crisis; dic abscncc of an integral, clear and siable water policy, a legal framework out of date. static one and of minimal fulfillmeni. which has allowed che inefficicrn use and ihe pollution ofihe water bodies. And certainly. hc dominecring culture of small ci no valuation to the water as vital resource for thc prcscnt and future dcvclopment of alI dic species. thai we populate che country.The Environmental Agenda of the Water in Costa Rica has bccn claborated by means of a participatory proccss. which includes several social actors in diverse regions —Limon. Liberia and Great Metropolitan Area (GAM) These actors prioritized lO principal problems related to water resources and thcir potential solutions:1) The formal and informal education is very weak with regard to since as reaches the efficient and intelligeni use of thc water resources. Equally. dic boss of managing is weak for revert of spilt without social responsibilicy.2) The excessive centralization of che decisions with very little civil parlicipation. both in the organizational siructure and in the decision making process.3) The un.workability of ihe institutional and legal framewoik —ignorance cii che pan of civil society of che proces.ses of denunciation and others the denunciation niechanism is ioo slow and inefticieni, a reason for which dic cbtmants get tired and discouragc—.4) Thedeficientone and almosi voideconomic valuationofthe waier. which bears in mmd the integral managing of the basin and dic scarc h of dic permancncy of dic resource to future.5) Thc absence of water plans of basin where dic regulatory plan is a basic component.6) The unequal quality of the water for dic Costa Ricans according tooperacor of dic service and geographica] region.7) The pollution of superficial and underground waters.8) The absence of knowledgc. socializ.arion, systematizing and mobilization in relation co the waier managing. Thc increase of dic capacities is necessary so much tcchnical and scicntific like of change of culture and popular knowledge.9) Lack of basic information and clear mechanisms to be able to use it.10) Thc cxisting information aL preseni is dispersed in different organizations and in sorne investigators, which prevents ihe effective use of the same one.The Environmental Agenda of the Water in Costa Rica brings the costs near for the solution of the pointed problems previously. Costa Rica needs to invest about US$1.500 million Lo approach ihe integrated managcment of the water resources in the country.

Constraining FIR size, dust temperature and dust mass in ALPINE galaxies at redshift 4

The study of galaxies at high redshift plays a crucial role to understand the mechanism of galaxy formation and evolution. At redshifts just after the epoch of re-ionization (4CII] emission, respectively. Finally, we put these results in a broader context, by studying the dust size evolution as a function of cosmic time. We derive dust size measurements via a Gaussian fit in the image and uv plane. Out of the 23 FIR-continuum-detected targets, 20 have been considered in this work since they are isolated systems. Of these 20, 7 are spatially resolved; for each of the remaining 13, we provide an upper limit to the dust size. We find that the gas emission is more extended than the dust spatial scale, by a factor of 1.40±0.29, while the latter appears to be larger than the stellar emission size. Moreover, we do not find any significant trend for dust size as a function of the stellar mass and the redshift. In addition, we provide a minimum dust temperature estimate for the 7 resolved sources, for which we find Tmin∼16−19K. We also derive dust masses for the resolved sources, logMdust∼7−8M⊙.