Influence of delayed cholecystectomy after acute gallstone pancreatitis on recurrence: consequences of lack of resources

Introduction: Acute pancreatitis is often a relapsing condition, particularly when its triggering factor persists. Our goal is to determine the recurrence rate of acute biliary pancreatitis after an initial episode, and the time to relapse, as well as to identify the risk factors for recurrence. Material and method: We included all patients admitted for a first acute gallstone pancreatitis event during four years. Primary endpoints included readmission for recurrence and time to relapse. Results: We included 296 patients admitted on a total of 386 occasions. The incidence of acute biliary pancreatitis in our setting is 17.5/100,000 population/year. In all, 19.6% of pancreatitis were severe (22.6% of severe acute pancreatitis for first episodes versus 3.6% for recurring pancreatitis), with an overall mortality of 4.4%. Overall recurrence rate was 15.5%, with a median time to relapse of 82 days. In total, 14.2% of patients relapsed after an acute pancreatitis event without cholecystectomy or endoscopic retrograde cholangio-pancreatography. Severe acute pancreatitis recur in 7.2% of patients, whereas mild cases do so in 16.3%, this being the only risk factor for recurrence thus far identified. Conclusions: Patients admitted for pancreatitis should undergo cholecystectomy as soon as possible or be guaranteed priority on the waiting list. Otherwise, endoscopic retrograde cholangio-pancreatography with sphincterotomy may be an alternative to surgery for selected patients.

Impacto da relação entre médico veterinário e proprietário no tratamento recebido por felinos domésticos

Dissertação de Mestrado Integrado em Medicina Veterinária

Lot production size problem and simulation of urban transport

OBJECTIVES AND STUDY METHOD: There are two subjects in this thesis: “Lot production size for a parallel machine scheduling problem with auxiliary equipment” and “Bus holding for a simulated traffic network”. Although these two themes seem unrelated, the main idea is the optimization of complex systems. The “Lot production size for a parallel machine scheduling problem with auxiliary equipment” deals with a manufacturing setting where sets of pieces form finished products. The aim is to maximize the profit of the finished products. Each piece may be processed in more than one mold. Molds must be mounted on machines with their corresponding installation setup times. The key point of our methodology is to solve the single period lot-sizing decisions for the finished products together with the piece-mold and the mold-machine assignments, relaxing the constraint that a single mold may not be used in two machines at the same time. For the “Bus holding for a simulated traffic network” we deal with One of the most annoying problems in urban bus operations is bus bunching, which happens when two or more buses arrive at a stop nose to tail. Bus bunching reflects an unreliable service that affects transit operations by increasing passenger-waiting times. This work proposes a linear mathematical programming model that establishes bus holding times at certain stops along a transit corridor to avoid bus bunching. Our approach needs real-time input, so we simulate a transit corridor and apply our mathematical model to the data generated. Thus, the inherent variability of a transit system is considered by the simulation, while the optimization model takes into account the key variables and constraints of the bus operation. CONTRIBUTIONS AND CONCLUSIONS: For the “Lot production size for a parallel machine scheduling problem with auxiliary equipment” the relaxation we propose able to find solutions more efficiently, moreover our experimental results show that most of the solutions verify that molds are non-overlapping even if they are installed on several machines. We propose an exact integer linear programming, a Relax&Fix heuristic, and a multistart greedy algorithm to solve this problem. Experimental results on instances based on real-world data show the efficiency of our approaches. The mathematical model and the algorithm for the lot production size problem, showed in this research, can be used for production planners to help in the scheduling of the manufacturing. For the “Bus holding for a simulated traffic network” most of the literature considers quadratic models that minimize passenger-waiting times, but they are harder to solve and therefore difficult to operate by real-time systems. On the other hand, our methodology reduces passenger-waiting times efficiently given our linear programming model, with the characteristic of applying control intervals just every 5 minutes.

Estruturas metodológicas direcionadas ao ensino de cinemática para educandos diagnosticados com TDAH : utilizando o modellus como interface interativa entre a teoria e a experimentação

Dissertação (mestrado)—Universidade de Brasília, Instituto de Física, Programa de Pós-Graduação em Física, 2015.

O contributo da animação na qualidade de vida dos idosos do serviço de apoio domiciliário do centro comunitário de Estoi

Dissertação de Mestrado, Educação Social, Escola Superior de Educação e Comunicação, Universidade do Algarve, 2016

Alternativas de ultimação de resíduo plástico termofixo

In the present work it was developed originals alternatives of enveronmentally safe and economically viable destination of thermoset plastic residue from a button factory, which at presnte stores such residue tempor and in a way that is inconvenient to the atmosphere, a waiting safe solutions. As the residue is not recycleab and its burning leberates strongly aggressive gases, safe alternatives were researched. Inicially, ghe residue in incineration was performed in cement ovens with precise control ofe emission of gases, but it was proved inviable due to its low calorific power, as well as the liberation of free lead in the ashes. An original and feasible option was the residue confinemente in soil-ciment blocks, lohich resulted in blocks highly resistant to simple compression with structural block, and also a significant increase in thermal resistence. Was got up other options of original and important composites as: making of blocks for pré-moulded flagstone, internal coating of walls with plaster being obtained good texture results, replenish of ceramic blocks and blocks with cement, also implying in increase of thermal resistance. Besides these original and scientific contributions, the it was technologically contribution of defreadation with suggestions of the material using torch of thermal plasm; for this was projected, built, characterized and tested a torch to it shapes it being obtained exciting results for the development of this technology come back for ending destruction from all the types of inconvenient garbage to the atmosphere

Postnatal Evaluation and Outcome of Prenatal Hydronephrosis

Background: Prenatal hydronephrosis (PNH) is dilation in urinary collecting system and is the most frequent neonatal urinary tract abnormality with an incidence of 1% to 5% of all pregnancies. PNH is defined as anteroposterior diameter (APD) of renal pelvis ≥ 4 mm at gestational age (GA) of < 33 weeks and APD ≥ 7 mm at GA of ≥ 33 weeks to 2 months after birth. All patients need to be evaluated after birth by postnatal renal ultrasonography (US). In the vast majority of cases, watchful waiting is the only thing to do; others need medical or surgical therapy. Objectives: There is a direct relationship between APD of renal pelvis and outcome of PNH. Therefore we were to find the best cutoff point APD of renal pelvis which leads to surgical outcome. Patients and Methods: In this retrospective cohort study we followed 200 patients 1 to 60 days old with diagnosis of PNH based on before or after birth ultrasonography; as a prenatal or postnatal detected, respectively. These patients were referred to the nephrology clinic in Zahedan Iran during 2011 to 2013. The first step of investigation was a postnatal renal US, by the same expert radiologist and classifying the patients into 3 groups; normal, mild/moderate and severe. The second step was to perform voiding cystourethrogram (VCUG) for mild/moderate to severe cases at 4 - 6 weeks of life. Tc-diethylene triamine-pentaacetic acid (DTPA) was the last step and for those with normal VCUG who did not show improvement in follow-up examination, US to evaluate obstruction and renal function. Finally all patients with mild/moderate to severe PNH received conservative therapy and surgery was preserved only for progressive cases, obstruction or renal function ≤35%. All patients’ data and radiologic information was recorded in separate data forms, and then analyzed by SPSS (version 22). Results: 200 screened PNH patients with male to female ratio 3.5:1 underwent first postnatal control US, of whom 65% had normal, 18% mild/moderate and 17% severe hydronephrosis. 167 patients had VCUG of whom 20.82% with VUR. 112 patients performed DTPA with following results: 50 patients had obstruction and 62 patients showed no obstructive finding. Finally 54% of 200 patients recovered by conservative therapy, 12.5% by surgery and remaining improved without any surgical intervention. Conclusions: The best cutoff point of anteroposterior renal pelvis diameter that led to surgery was 15 mm, with sensitivity 88% and specificity 74%.

"I’ll call you when we are ready" (One family’s experience of critical care and end of life decision making)

The purpose of this paper is to explore through narrative accounts one family's expérience of critical care, after the admission of a family member to an Intensive Care Unit (ICU) and their subséquent death five weeks later. Numerous studies support the need for effective communication and clear information to be given to the family. In this instance it was évident from their stories that there were numerous barriers to communication, including language and a lack of insight into the needs of the family. Many families do not understand the complexities of nursing care in an ICU so lack of communication by nursing staff was identified as uncaring behavior and encounters. Facilitating a family's proximity to a dying patient and encouraging them to participate in care helps to maintain some sensé of personal control. Despite a commitment to involving family members in care, which was enshrined in the Unit Philosophy, relatives were banished to the waiting room for hours. They experienced feelings of powerlessness and helplessness as they waited with other relatives for news following investigations or until 'the doctor had completed his rounds'. Explanations of "we must make 'the patient' comfortable" was no consolation for those who wished to be involved in care. The words "I'il call you when we are ready" became a mantra to the forgotten families who waited patiently for those with power to admit them to the ICU. Implications are this family felt they were left alone to cope with the traumatic expériences leading up to and surrounding the death. They felt mainly supported by the priest, who not only administered the last rites but provided spiritual support to the family and dealt sensitively with many issues. Paternalism in décision making when there is a moral obligation to ensure that discussions on end of life dilemmas are an inclusive process with families, doctors, nurses was not understood, therefore it caused conflict within the family over EOL décision making. The family felt that the opportunity to share expériences through telling and retelling their stories would enable them to reconfigure the past and create purpose in the future.

Insights into the Fallback Path of Best-Effort Hardware Transactional Memory Systems

Current industry proposals for Hardware Transactional Memory (HTM) focus on best-effort solutions (BE-HTM) where hardware limits are imposed on transactions. These designs may show a significant performance degradation due to high contention scenarios and different hardware and operating system limitations that abort transactions, e.g. cache overflows, hardware and software exceptions, etc. To deal with these events and to ensure forward progress, BE-HTM systems usually provide a software fallback path to execute a lock-based version of the code. In this paper, we propose a hardware implementation of an irrevocability mechanism as an alternative to the software fallback path to gain insight into the hardware improvements that could enhance the execution of such a fallback. Our mechanism anticipates the abort that causes the transaction serialization, and stalls other transactions in the system so that transactional work loss is mini- mized. In addition, we evaluate the main software fallback path approaches and propose the use of ticket locks that hold precise information of the number of transactions waiting to enter the fallback. Thus, the separation of transactional and fallback execution can be achieved in a precise manner. The evaluation is carried out using the Simics/GEMS simulator and the complete range of STAMP transactional suite benchmarks. We obtain significant performance benefits of around twice the speedup and an abort reduction of 50% over the software fallback path for a number of benchmarks.

Lieu de liens, lieu de vie : oser le réseau comme alternative à la vulnérabilité : le cas des demandeurs d’asile à Projet Refuge (Montréal).

La vulnérabilité est l’attribut fondamental justifiant le passage des frontières du refuge canadien (Rousseau et al., 2002 ; Clément et Bolduc, 2004). Elle est preuve d’insécurité pour la victime requérant l’asile ; elle est aussi porteuse d’espérance de sécurité en terre hospitalière. Elle est pourtant potentiel réactualisé dans l’insécurité d’un statut incertain en terre d’accueil (Agamben, 1997 ; D’Halluin, 2004). Violente immersion. En attendant que les preuves de sa vulnérabilité originelle soient validées, le demandeur d’asile se retrouve dans un entre-deux a-territorial et atemporel (Agier, 2002 ; Le Blanc, 2010) et dans une précarité tout aussi dangereuse (Ouimet et al., 2009). Des besoins émergent en cette terre inconnue, or l’accès aux soins de santé lui est limité par des textes de lois ambigus et leurs interprétations maladroites (Harris et Zuberi, 2015). Ainsi lorsqu’il se heurte à des barrières érigées par une transmission d’informations défectueuse, sa précarité ne fait qu’empirer. Tel un boomerang, ce paradoxe cultive leur vulnérabilité. Alors que les recherches interrogent les divers intervenants en santé (Asgary et Smith, 2013), j’ai choisi de donner la parole aux premiers concernés et de relayer leur vécu par rapport à leur propre personne. Deux objectifs principaux guident la recherche : documenter dans un premier temps leur parcours de quête de soins à partir de la circulation des informations formelles et informelles dans le but de sonder leur avis sur la vulnérabilité qui leur est attribuée ; documenter dans un second temps leur parcours migratoire de quête de soi afin de mettre en lumière les stratégies alternatives d’entrée en contact avec la société d’accueil pour négocier voire rejeter cette identité vulnérable. J’ai rencontré pour cela des demandeurs d’asile lors d’un terrain de huit mois au sein d’un organisme communautaire d’hébergement à Montréal. Dans ce contexte d’accompagnement et de stabilité spatiale, accalmie bienvenue au terme d’un itinéraire semé d’embûches, les ressources informationnelles sont à leur disposition et la reconnaissance sociale est à l’honneur. En parallèle, beaucoup témoignent de la diminution de leurs besoins de soins de santé. En cette communauté thérapeutique (Pocreau, 2005), véritable tremplin vers la société d’accueil en attendant un statut reconnu, ils bénéficient d’une possibilité de participation sociale et d’un sentiment d’appartenance valorisant. Si des conditions précaires peuvent aggraver la vulnérabilité, le bricolage de conditions positives favorise la résilience (Cleveland et al., 2014), créant un environnement revitalisant qui leur permet de rebondir.

Lieu de liens, lieu de vie : oser le réseau comme alternative à la vulnérabilité : le cas des demandeurs d’asile à Projet Refuge (Montréal)

La vulnérabilité est l’attribut fondamental justifiant le passage des frontières du refuge canadien (Rousseau et al., 2002 ; Clément et Bolduc, 2004). Elle est preuve d’insécurité pour la victime requérant l’asile ; elle est aussi porteuse d’espérance de sécurité en terre hospitalière. Elle est pourtant potentiel réactualisé dans l’insécurité d’un statut incertain en terre d’accueil (Agamben, 1997 ; D’Halluin, 2004). Violente immersion. En attendant que les preuves de sa vulnérabilité originelle soient validées, le demandeur d’asile se retrouve dans un entre-deux a-territorial et atemporel (Agier, 2002 ; Le Blanc, 2010) et dans une précarité tout aussi dangereuse (Ouimet et al., 2009). Des besoins émergent en cette terre inconnue, or l’accès aux soins de santé lui est limité par des textes de lois ambigus et leurs interprétations maladroites (Harris et Zuberi, 2015). Ainsi lorsqu’il se heurte à des barrières érigées par une transmission d’informations défectueuse, sa précarité ne fait qu’empirer. Tel un boomerang, ce paradoxe cultive leur vulnérabilité. Alors que les recherches interrogent les divers intervenants en santé (Asgary et Smith, 2013), j’ai choisi de donner la parole aux premiers concernés et de relayer leur vécu par rapport à leur propre personne. Deux objectifs principaux guident la recherche : documenter dans un premier temps leur parcours de quête de soins à partir de la circulation des informations formelles et informelles dans le but de sonder leur avis sur la vulnérabilité qui leur est attribuée ; documenter dans un second temps leur parcours migratoire de quête de soi afin de mettre en lumière les stratégies alternatives d’entrée en contact avec la société d’accueil pour négocier voire rejeter cette identité vulnérable. J’ai rencontré pour cela des demandeurs d’asile lors d’un terrain de huit mois au sein d’un organisme communautaire d’hébergement à Montréal. Dans ce contexte d’accompagnement et de stabilité spatiale, accalmie bienvenue au terme d’un itinéraire semé d’embûches, les ressources informationnelles sont à leur disposition et la reconnaissance sociale est à l’honneur. En parallèle, beaucoup témoignent de la diminution de leurs besoins de soins de santé. En cette communauté thérapeutique (Pocreau, 2005), véritable tremplin vers la société d’accueil en attendant un statut reconnu, ils bénéficient d’une possibilité de participation sociale et d’un sentiment d’appartenance valorisant. Si des conditions précaires peuvent aggraver la vulnérabilité, le bricolage de conditions positives favorise la résilience (Cleveland et al., 2014), créant un environnement revitalisant qui leur permet de rebondir.

A virtual agent to sustaining children's engagement in language learning

In this thesis we aimed to explore the potential of gamification - defined as “the use of game elements in non-game contexts” [30] - in increasing children's (aged 5 to 6) engagement with the task. This is mainly due to the fact that our world is living a technological era, and videogames are an example of this engagement by being able to maintain children’s (and adults) engagement for hours straight. For the purpose of limiting complexity, we only addressed the feedback element by introducing it with an anthropomorphic virtual agent (human-like aspect), because research shows that virtual agents (VA’s) can influence behavioural change [17], or even induce emotions on humans both through the use of feedback provided and their facial expressions, which can interpreted in the same way as of humans’ [2]. By pairing the VA with the gamification concept, we wanted to 1) create a VA that is likely to be well-received by children (appearance and behaviour), and 2) have the immediate feedback that games have, so we can give children an assessment of their actions in real-time, as opposed to waiting for feedback from someone (traditional teaching), and with this give students more chances to succeed [32, 43]. Our final system consisted on a virtual environment, where children formed words that corresponded to a given image. In order to measure the impact that the VA had on engagement, the system was developed in two versions: one version of the system was limited to provide a simple feedback environment, where the VA provided feedback, by responding with simple phrases (i.e. “correct” or “incorrect”); for the second version, the VA had a more complex approach where it tried to encourage children to complete the word – a motivational feedback - even when they weren’t succeeding. Lastly we conducted a field study with two groups of children, where one group tested the version with the simple feedback, and the other group tested the ‘motivational’ version of the system. We used a quantitative approach to analyze the collected data that measured the engagement, based on the number of tasks (words) completed and time spent with system. The results of the evaluation showed that the use of motivational feedback may carry a positive effect on engaging children.

Motivating the use of public transit through a mobile glanceable display

With increasing concerns about the impact of global warming on human life, policy makers around the world and researchers have sought for technological solutions that have the potential to attenuate this process. This thesis describes the design and evaluation of an information appliance that aims to increase the use of public transportation. We developed a mobile glanceable display that, being aware of the user’s transportation routines, provides awareness cues about bus arrival time, grounded upon the vision of Ambient Intelligence. We present the design process we followed, from ideation to building a prototype and conducting a field study, and conclude with a set of guidelines for the design of relevant personal information systems. More specifically we seek to test the following hypotheses: 1) That the tangible prototype that provides ambient cues will be used more frequently than a similar purpose mobile app, 2) That the tangible prototype will reduce the waiting time at the bus stop, 3) That the tangible prototype will result to reduced anxiety on passengers, 4) That the tangible prototype will result to an increase in the perceived reliability of the transit service, 5) That the tangible prototype will enhance users’ efficiency in reading the bus schedules and 6) That the tangible prototype will make individuals more likely to use public transit. In a field study, we compare the tangible prototype against the mobile app and a control condition where participants were given no external support in obtaining bus arrival information, other than their existing routines. Using qualitative and quantitative data, we test the aforementioned hypotheses and explore users’ reactions to the prototype we developed.

A national referral of an integrated network of continuing care a study case

This study aims to characterize the National Long-Term Care Network (NL-TCN) users. The Portuguese National Health Service, was restructured in 2006 with the creation of the National Long-Term Care Network to respond to new health and social needs concerning the continuity of care. Objectives- Analyse the sociodemographic profile of the network users and the review of hospital, local and regional management procedures. Methods-we used various methods of observational or experimental nature (data processing and presentation of results with the program Statistical Package for Social Sciences, version 20, descriptive statistics (frequencies, crosstabs and test chi-square)). The Pearson correlation test showed a positive correlation between time procedures at the local and regional management and hospital’s length of stay. Results- from a sample of 805 cases, 595 (74%) were admitted in the NL-TCN, a rate lower than the national average (86%). Almost half of the sample was admitted in Rehabilitation Units (46%), while nationally the highest number of admissions was in Home Care Teams (30%). The average time from hospital referral to network admission was 9.73 days with a positive correlation between referred network management procedures and hospital length of stay. Conclusions- For specialized units, the maximum waiting times were for the Long-Term and Support Units (mean 30.27 days) and the minimum waiting times were for Home Care Teams (mean 5.57 days). The average time between the local and regional management was 3.59 days. Almost 90% of referrals were orthopaedics, internal medicine and neurology and Network users were mostly elderly (average 75 years old), female and married. Most users were admitted to inpatient units (78%) and only 15% remained in their home town.

Applicant Reference Guide For Individuals Filing For Unemployment Insurance Benefits

This guide gives important information about how to receive unemployment benefits. Topics include: Privacy Act, Equal Opportunity Statement, Income and Eligibility Verification Notice, Unemployment Insurance Benefits, Eligibility requirements, Unemployment Compensation for Federal Employees, Employment Compensation for Ex-Servicemembers,School Worker Claims, Pension Reduction, Official Court Appearances and Benefit eligibility, Benefits are Based on Wages Paid, Initial Determination, Benefit Year, Waiting Period, Maximum Weekly Benefit Amount, To Establish a Weekly Benefit Amount, Disqualification, Fraudulent claims, Requests for Reconsideration, Appeal Provisions, Standard and Alternate Base Period Explained, Partial Employment,Self-Employment, Students, Interstate Benefits, Benefits Will Be Taxable, Individual Benefits, Filing Your Weekly Claim, Filing Your Weekly Claim Online,Filing Your Weekly Claim by TelClaim and New Hires.