Langattoman Internet-puhelupalvelun tarjoaminen

Langattomalla Internetpuhelupalvelulla tarkoitetaan Internet-puheluiden (Voice over Internet Protocol, VoIP) siirtoa langattoman tiedonsiirtoverkon ylitse. Tälläisia langattomia verkkoja voivat olla esimerkiksi langattomat lähiverkot, WiMAX-verkot tai 450 megahertsin (MHz) taajuusalueella toimivat tiedonsiirtoverkot. VoIP-yhteyden toiminta voidaan jakaa kolmeen eri toiminta-alueeseen: yhteydenmuodostusprotokollaan, äänen koodaukseen sekä siirtotiehen. Yhteydenmuodostusprotokollia ovat esimerkiksi SIP (Session Initiation Protocol) sekä H.323. Yhteydenmuodostusprotokollantehtävänä on muodostaa yhteys käyttäjien välille sekä sopia yhteydessäkäytettävistä ominaisuuksista. Äänen koodauksessa ääni pakataan paketteihin, joita lähetetään siirtotietä pitkin eri käyttäjien välillä. Normaalissa Internetpuheluyhteydessä siirtotienä käytetään langallisia siirtoteitä. Tässä työssä on keskitytty langattomiin siirtoteihin ja niidentuomiin haasteisiin, kuten yhteyden luotettavuuteen ja laatuun, yhteyskapasiteetin riittävyyteen sekä siirtymiseen saman verkon eri tukiasemien sekä eri verkkojen välillä. Työssä rakennettiin yksinkertainen, mutta toimiva langaton Internetpuhelujärjestelmä sekä verrattiin sen ominaisuuksia normaaliin Internetpuhelujärjestelmään. Järjestelmää koekäytettiin oikeassa toimintatilanteessa varsinaisen puhelinjärjestelmän rinnalla tavallisessa toimistoympäristössä. Testaustulosten ja käyttäjäkokemusten perusteella on periaatteessa mahdollista rakentaa yksinkertainen langaton Internetpuhelujärjestelmä ja käyttää sitä puhelupalveluiden tarjoamiseen. Palvelun tarjoaminen vaatii kuitenkin vielä tiettyjen viestintäviraston määräysten täyttämistä ennen tuotantokäyttöön ottamista.

Transfusion practice in early trauma management

Introduction: Blood transfusions carry risks and complications. At the University Hospital of Lausanne the need for transfusion in early trauma resuscitation is based on clinical judgment and standard laboratory tests. We aimed to assess the transfusion practice for trauma patients during their early management. Method: Based on 2008 data from the Lausanne Trauma Registry of Acute Care (TRAC), we analyzed all adult trauma patients admitted to the shock room who received blood products or pro-coagulants in shock room and/or during their emergency operation. Demographics, physiological parameters and lab tests were recorded at arrival and at the end of anesthesiologic management. Coagulopathy was defined as PT <70%, PTT >60 sec, Fibrinogen <1 g/l or Thrombocytes <100 x 109 g/l. Results: In 2008, 323 trauma-patients were included in TRAC. 55 patients (17%) received blood products or pro-coagulants. 44 (83%) had an ISS >15 (med 29, IQR 10-35.5). 43 (78.2%) needed an emergency intervention. Coagulopathy was present in 25 patients (45.5%) at arrival vs. 30 (54.5%) after resuscitation (p = 0.446).

Las “nuevas guerras” del siglo XXI. Tendencias de la conflictividad armada contemporánea

El paper analiza los cambios y las continuidades en los conflictos armados de alta intensidad, las guerras, en el siglo XXI, también llamadas “nuevas guerras”. Se propone un patrón de análisis en torno a diez variables: el número de conflictos, el nivel de intensidad, las víctimas que producen, el contexto espacial en que se desarrollan, las causas que los ocasionan y los objetivos que persiguen las partes, las tácticas e instrumentos de combate utilizados, la economía de los conflictos, las pautas regionales y la relación entre conflictividad armada de alta intensidad y seguridad. Se defiende que las trasformaciones experimentadas en la pauta de conflictividad armada no han conducido a un mundo más seguro sino que, al contrario, han exacerbado la dificultad de gestión de los conflictos debido a la mayor complejidad de los mismos, tanto por la multicausalidad de las incompatibilidades y el carácter estructural de muchas de ellas, como por el mayor número de actores y sobre todo por su diversidad, vinculado al hecho de que las normas e instituciones tradicionales de gestión de conflictos están pensadas para un tipo de conflictividad –la interestatal– en clara regresión, mientras que seguimos sin disponer de instrumentos normativos vinculantes adaptados a las nuevas necesidades, y los que existen no son aceptados por todos los Estados ni siquiera por todas las grandes potencias del sistema interestatal.

Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial.

BACKGROUND: Enteral nutrition (EN) is recommended for patients in the intensive-care unit (ICU), but it does not consistently achieve nutritional goals. We assessed whether delivery of 100% of the energy target from days 4 to 8 in the ICU with EN plus supplemental parenteral nutrition (SPN) could optimise clinical outcome. METHODS: This randomised controlled trial was undertaken in two centres in Switzerland. We enrolled patients on day 3 of admission to the ICU who had received less than 60% of their energy target from EN, were expected to stay for longer than 5 days, and to survive for longer than 7 days. We calculated energy targets with indirect calorimetry on day 3, or if not possible, set targets as 25 and 30 kcal per kg of ideal bodyweight a day for women and men, respectively. Patients were randomly assigned (1:1) by a computer-generated randomisation sequence to receive EN or SPN. The primary outcome was occurrence of nosocomial infection after cessation of intervention (day 8), measured until end of follow-up (day 28), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00802503. FINDINGS: We randomly assigned 153 patients to SPN and 152 to EN. 30 patients discontinued before the study end. Mean energy delivery between day 4 and 8 was 28 kcal/kg per day (SD 5) for the SPN group (103% [SD 18%] of energy target), compared with 20 kcal/kg per day (7) for the EN group (77% [27%]). Between days 9 and 28, 41 (27%) of 153 patients in the SPN group had a nosocomial infection compared with 58 (38%) of 152 patients in the EN group (hazard ratio 0·65, 95% CI 0·43-0·97; p=0·0338), and the SPN group had a lower mean number of nosocomial infections per patient (-0·42 [-0·79 to -0·05]; p=0·0248). INTERPRETATION: Individually optimised energy supplementation with SPN starting 4 days after ICU admission could reduce nosocomial infections and should be considered as a strategy to improve clinical outcome in patients in the ICU for whom EN is insufficient. FUNDING: Foundation Nutrition 2000Plus, ICU Quality Funds, Baxter, and Fresenius Kabi.

Risk factor impact on blood flow velocities and clinical outcomes of stented cervical and intracranial stenoses: preliminary observations.

OBJECTIVES: The role of angioplasty/stenting procedures, neurointerventionist experience, vascular risk factors, medical treatment and blood flow velocities were analysed to identify possible causes of intra-stent restenosis (ISR) following stenting of cervical and/or intracranial arteries, assuming progressive atherosclerosis to be the shared mechanism in both territories. Patients. 26 cerebrovascular patients subjected to stenting of severe (≥85%) symptomatic or asymptomatic carotid stenoses or moderate-to-severe (≥50%) intracranial or vertebral stenoses were included. METHODS: Clinical, radiological and ultrasonographic follow-up data were analysed retrospectively. RESULTS: Overall, stenting of the internal carotid artery (ICA) induced significant reductions in peak systolic velocities at 2 years (96±31cm/s vs. 358.2±24.9cm/s at baseline). The procedure-related ischemic complications rate was 7.4% (one hemispheric stroke and one TIA). The rate of ISR≤50% was 8% in the ICA at 2 years; was 50% in the common carotid artery (CCA) at 1 year, with concomitant distal ICA stenosis in 75% of CCA stenting, but all ISR were asymptomatic. Patients with ISR of the ICA were significantly younger (56.8±4.5 vs. 71.3±3.6 years, P=0.042) and had significantly more risk factors (5.5±0.9 vs. 3±0.3, P=0.012). No ISR≥70% was detected. CONCLUSIONS: ISR is relatively infrequent and, when present, it is mild and asymptomatic. Restenosis is more frequent in younger patients and those with several risk factors, and it may also be related to stenting of previous carotid endarterectomy.

Dépendances [Addiction].

The news in addiction medicine for 2011 include new knowledges coming from the neurosciences, but also new clinical concepts, as the role of hospital addiction units in an integrated network of care. The issue of cocaine vaccination is discussed from an ethical point of view. Finally, the integration of mindfulness techniques is introduced as a useful approach in the treatment of the addictions.

Reexamination of the relationship of resting metabolic rate to fat-free mass and to the metabolically active components of fat-free mass in humans.

The ratio of resting metabolic rate (RMR) to fat-free mass (FFM) is often used to compare individuals of different body sizes. Because RMR has not been well described over the full range of FFM, a literature review was conducted among groups with a wide range of FFM. It included 31 data sets comprising a total of 1111 subjects: 118 infants and preschoolers, 323 adolescents, and 670 adults; FFM ranged from 2.8 to 106 kg. The relationship of RMR to FFM was found to be nonlinear and average slopes of the regression equations of the three groups differed significantly (P less than 0.0001). For only the youngest group did the intercept approach zero. The lower slopes of RMR on FFM, at higher measures of FFM, corresponded to relatively greater proportions of less metabolically active muscle mass and to lesser proportions of more metabolically active nonmuscle organ mass. Because the contribution of FFM to RMR is not constant, an arithmetic error is introduced when the ratio of RMR to FFM is used. Hence, alternative methods should be used to compare individuals with markedly different FFM.

Conflict-based Method for Conceptual Process Synthesis

The changing business environment demands that chemical industrial processes be designed such that they enable the attainment of multi-objective requirements and the enhancement of innovativedesign activities. The requirements and key issues for conceptual process synthesis have changed and are no longer those of conventional process design; there is an increased emphasis on innovative research to develop new concepts, novel techniques and processes. A central issue, how to enhance the creativity of the design process, requires further research into methodologies. The thesis presentsa conflict-based methodology for conceptual process synthesis. The motivation of the work is to support decision-making in design and synthesis and to enhance the creativity of design activities. It deals with the multi-objective requirements and combinatorially complex nature of process synthesis. The work is carriedout based on a new concept and design paradigm adapted from Theory of InventiveProblem Solving methodology (TRIZ). TRIZ is claimed to be a `systematic creativity' framework thanks to its knowledge based and evolutionary-directed nature. The conflict concept, when applied to process synthesis, throws new lights on design problems and activities. The conflict model is proposed as a way of describing design problems and handling design information. The design tasks are represented as groups of conflicts and conflict table is built as the design tool. The general design paradigm is formulated to handle conflicts in both the early and detailed design stages. The methodology developed reflects the conflict nature of process design and synthesis. The method is implemented and verified through case studies of distillation system design, reactor/separator network design and waste minimization. Handling the various levels of conflicts evolve possible design alternatives in a systematic procedure which consists of establishing an efficient and compact solution space for the detailed design stage. The approach also provides the information to bridge the gap between the application of qualitative knowledge in the early stage and quantitative techniques in the detailed design stage. Enhancement of creativity is realized through the better understanding of the design problems gained from the conflict concept and in the improvement in engineering design practice via the systematic nature of the approach.

Las monedas con nombres de étnicos del s. II a.C. en el nordeste peninsular: ¿Reflejo de posibles circunscripciones? ¿Civitates con doble nombre?

En el s. II a.C. se emiten en el nordeste de Hispania monedas con el nombre de étnicos conocidos por las fuentes escritas. Se plantea el problema de si responden a una organización territorial en circunscripciones que, curiosamente, correponden con las regiones principales populi que cita Plinio. Por otro lado estas cecas podrían corresponder a localidades que pudieran tener otro nombre.

La repercusión del régimen constitucional en la Iglesia de Lleida durante el trienio liberal

A principios del año 1820 la revolución de Rafael de Riego instauró el régimen liberal en España. La Iglesia de Lleida se adaptó correctamente al nuevo modelo político. Pero la obra legislativa de las Cortes liberales perjudicó gravemente a todas las estructuras políticas, económicas y sociales de la institución eclesiástica. Con la radicalización del gobierno liberal se produjo la ruptura de las relaciones de los con el Ayuntamiento de Lleida, quiénes al poco tiempo sufrieron la persecución y la represión de las autoridades liberales. Por tanto, el balance del período liberal fue muy negativo y su impacto enorme.

Incidência de danos pós-colheita em goiabas no mercado atacadista de São Paulo e sua relação com a prática de ensacamento dos frutos

A incidência de danos pós-colheita em goiabas foi quantificada no período de abril de 2005 a agosto de 2006 em quatro permissionários do Entreposto Terminal de São Paulo da Companhia de Entrepostos e Armazéns Gerais de São Paulo (CEAGESP). As amostragens foram feitas de forma estratificada, utilizando calibre, procedência, cor da polpa e ensacamento do fruto como critérios de estratificação. Injúrias mecânicas e doenças pós-colheita foram quantificadas por meio de análise visual de todos os frutos de 323 caixas de goiaba. Foram avaliados 5.081 frutos, dos quais 51,1 % foram provenientes de pomares onde a prática do ensacamento dos frutos era utilizada. Injúrias mecânicas pós-colheita foram observadas em 63 % dos frutos, mas apenas 5,5 % dos frutos mostraram sintomas de doenças. A incidência de doenças pós-colheita foi correlacionada à incidência de injúrias mecânicas apenas nos frutos ensacados (R=0,20, p< 0,05). Essas variáveis não foram correlacionadas nos frutos não- ensacados (R=0,09). Pinta-preta (Guignardia psidii) foi observada em 3,5 % dos frutos e antracnose (Colletotrichum spp.), em 1,1 % deles. Podridões pós-colheita ocasionadas pelos fungos dos gêneros Fusicoccum, Rhizopus e Pestalotia ocorreram em menos de 1% dos frutos. A incidência de doenças provocadas por patógenos quiescentes foi significativamente maior em frutos ensacados (7,7 % dos frutos) que em frutos não-ensacados (2,1 % dos frutos). O oposto foi observado para patógenos que penetram o fruto exclusivamente por ferimentos, cujas médias foram de 0,3 % e 0,8 % de incidência de frutos sintomáticos, respectivamente para frutos ensacados e não-ensacados. Não houve diferença estatística significativa na incidência de doenças quiescentes nos frutos ensacados das variedades de polpa branca (7,8 %) e nas variedades de polpa vermelha (7,3 %).