Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy. A Multi-Institutional Analysis.

PURPOSE The impact of cardiopulmonary bypass in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We determine the impact of cardiopulmonary bypass on overall and cancer specific survival, as well as surgical complication rates and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without cardiopulmonary bypass. MATERIALS AND METHODS We retrospectively analyzed 362 patients with renal cell cancer and with level III or IV tumor thrombus from 1992 to 2012 at 22 U.S. and European centers. Cox proportional hazards models were used to compare overall and cancer specific survival between patients with and without cardiopulmonary bypass. Perioperative mortality and complication rates were assessed using logistic regression analyses. RESULTS Median overall survival was 24.6 months in noncardiopulmonary bypass cases and 26.6 months in cardiopulmonary bypass cases. Overall survival and cancer specific survival did not differ significantly in both groups on univariate analysis or when adjusting for known risk factors. On multivariate analysis no significant differences were seen in hospital length of stay, Clavien 1-4 complication rate, intraoperative or 30-day mortality and cancer specific survival. Limitations include the retrospective nature of the study. CONCLUSIONS In our multi-institutional analysis the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality on multivariate analysis. Greater surgical complications were not independently associated with the use of cardiopulmonary bypass.

An analysis of the RightCare policy at Ben Taub General Hospital, Houston, Texas

Introduction. This study is a two-part evaluation of the RightCare policy, a policy implemented to reduce crowding at the Emergency Center (EC) at Ben Taub General Hospital in Houston, Harris County, Texas. This research includes an evaluation of the policy's impact on specific hospital measures, along with a description of the policy's demise from the point of view of hospital staff. Objective. The purpose of this study is two-fold: (1) To determine whether RightCare policy affected the level of crowding in the Emergency Center and (2) to identify the conditions that may have led to the policy's demise. Methods. For the policy impact portion of this research, hospital measures were collected from existing databases. Analysis included a pre-post comparative design in which the 12 months preceding the policy's implementation were compared with the 12 months following the policy's implementation. For the policy perception portion, employees were surveyed using an on-line questionnaire. Results. The results of the study are mixed. Some measures improved, including time spent on ambulance diversion and the proportion of those who left without being seen, while others did not, such as return visits and total length of stay. Employees generally supported the policy, but expressed concerns over insufficient training and funding. Conclusion. The RightCare policy was a good initial attempt to improve crowded conditions in the EC. The study showed that a clearer policy design, improved training, adequate staffing levels, and better communication would improve operational outcomes in the future.^

Social support, health status and health services utilization among the noninstitutionalized elderly: An analysis of the Supplement on Aging to the 1984 national health interview survey

The association between Social Support, Health Status, and Health Services Utilization of the elderly, was explored based on the analysis of data from the Supplement on Aging to the National Health Interview Survey, 1984 (N = 11,497) using a modified framework of Aday and Andersen's Expanded Behavioral Model. The results suggested that Social Support as operationalized in this study was an independent determinant of the use of health services. The quantity of social activities and the use of community services were the two most consistent determinants across different types of health services use.^ The effects of social support on the use of health services were broken down into three components to facilitate explanations of the mechanisms through which social support operated. The Predisposing and Enabling component of Social Support had independent, although not uniform, effects on the use of health services. Only slight substitute effects of social support were detected. These included the substitution of the use of senior centers for longer stay in the hospital and the substitution of help with IADL problems for the use of formal home care services.^ The effect of financial support on the use of health services was found to be different for middle and low income populations. This differential effect was also found for the presence of intimate networks, the frequencies of interaction with children and the perceived availability of support among urban/rural, male/female and white/non-white subgroups.^ The study also suggested that the selection of appropriate Health Status measures should be based on the type of Health Services Utilization in which a researcher is interested. The level of physical function limitation and role activity limitation were the two most consistent predictors of the volume of physician visits, number of hospital days, and average length of stay in the hospital during the past year.^ Some alternative hypotheses were also raised and evaluated, when possible. The impacts of the complex sample design, the reliability and validity of the measures and other limitations of this analysis were also discussed. Finally, a revised framework was proposed and discussed based on the analysis. Some policy implications and suggestions for future study were also presented. ^

The application of principal component analysis on human development indicators: Temporal approach from 1999 to 2010

Background and Objective. Ever since the human development index was published in 1990 by the United Nations Development Programme (UNDP), many researchers started searching and corporative studying for more effective methods to measure the human development. Published in 1999, Lai’s “Temporal analysis of human development indicators: principal component approach” provided a valuable statistical way on human developmental analysis. This study presented in the thesis is the extension of Lai’s 1999 research. ^ Methods. I used the weighted principal component method on the human development indicators to measure and analyze the progress of human development in about 180 countries around the world from the year 1999 to 2010. The association of the main principal component obtained from the study and the human development index reported by the UNDP was estimated by the Spearman’s rank correlation coefficient. The main principal component was then further applied to quantify the temporal changes of the human development of selected countries by the proposed Z-test. ^ Results. The weighted means of all three human development indicators, health, knowledge, and standard of living, were increased from 1999 to 2010. The weighted standard deviation for GDP per capita was also increased across years indicated the rising inequality of standard of living among countries. The ranking of low development countries by the main principal component (MPC) is very similar to that by the human development index (HDI). Considerable discrepancy between MPC and HDI ranking was found among high development countries with high GDP per capita shifted to higher ranks. The Spearman’s rank correlation coefficient between the main principal component and the human development index were all around 0.99. All the above results were very close to outcomes in Lai’s 1999 report. The Z test result on temporal analysis of main principal components from 1999 to 2010 on Qatar was statistically significant, but not on other selected countries, such as Brazil, Russia, India, China, and U.S.A.^ Conclusion. To synthesize the multi-dimensional measurement of human development into a single index, the weighted principal component method provides a good model by using the statistical tool on a comprehensive ranking and measurement. Since the weighted main principle component index is more objective because of using population of nations as weight, more effective when the analysis is across time and space, and more flexible when the countries reported to the system has been changed year after year. Thus, in conclusion, the index generated by using weighted main principle component has some advantage over the human development index created in UNDP reports.^

Contribution to the Analysis, Design and Assessment of Compact Antenna Test Ranges At Millimeter Wavelengths - Contribución al Análisis, Diseño y Caracterización de Sistemas de Medida de Antenas en Rango Compacto para Frecuencias Milimétricas

This Doctoral Thesis entitled Contribution to the analysis, design and assessment of compact antenna test ranges at millimeter wavelengths aims to deepen the knowledge of a particular antenna measurement system: the compact range, operating in the frequency bands of millimeter wavelengths. The thesis has been developed at Radiation Group (GR), an antenna laboratory which belongs to the Signals, Systems and Radiocommunications department (SSR), from Technical University of Madrid (UPM). The Radiation Group owns an extensive experience on antenna measurements, running at present four facilities which operate in different configurations: Gregorian compact antenna test range, spherical near field, planar near field and semianechoic arch system. The research work performed in line with this thesis contributes the knowledge of the first measurement configuration at higher frequencies, beyond the microwaves region where Radiation Group features customer-level performance. To reach this high level purpose, a set of scientific tasks were sequentially carried out. Those are succinctly described in the subsequent paragraphs. A first step dealed with the State of Art review. The study of scientific literature dealed with the analysis of measurement practices in compact antenna test ranges in addition with the particularities of millimeter wavelength technologies. Joint study of both fields of knowledge converged, when this measurement facilities are of interest, in a series of technological challenges which become serious bottlenecks at different stages: analysis, design and assessment. Thirdly after the overview study, focus was set on Electromagnetic analysis algorithms. These formulations allow to approach certain electromagnetic features of interest, such as field distribution phase or stray signal analysis of particular structures when they interact with electromagnetic waves sources. Properly operated, a CATR facility features electromagnetic waves collimation optics which are large, in terms of wavelengths. Accordingly, the electromagnetic analysis tasks introduce an extense number of mathematic unknowns which grow with frequency, following different polynomic order laws depending on the used algorithmia. In particular, the optics configuration which was of our interest consisted on the reflection type serrated edge collimator. The analysis of these devices requires a flexible handling of almost arbitrary scattering geometries, becoming this flexibility the nucleus of the algorithmia’s ability to perform the subsequent design tasks. This thesis’ contribution to this field of knowledge consisted on reaching a formulation which was powerful at the same time when dealing with various analysis geometries and computationally speaking. Two algorithmia were developed. While based on the same principle of hybridization, they reached different order Physics performance at the cost of the computational efficiency. Inter-comparison of their CATR design capabilities was performed, reaching both qualitative as well as quantitative conclusions on their scope. In third place, interest was shifted from analysis - design tasks towards range assessment. Millimetre wavelengths imply strict mechanical tolerances and fine setup adjustment. In addition, the large number of unknowns issue already faced in the analysis stage appears as well in the on chamber field probing stage. Natural decrease of dynamic range available by semiconductor millimeter waves sources requires in addition larger integration times at each probing point. These peculiarities increase exponentially the difficulty of performing assessment processes in CATR facilities beyond microwaves. The bottleneck becomes so tight that it compromises the range characterization beyond a certain limit frequency which typically lies on the lowest segment of millimeter wavelength frequencies. However the value of range assessment moves, on the contrary, towards the highest segment. This thesis contributes this technological scenario developing quiet zone probing techniques which achieves substantial data reduction ratii. Collaterally, it increases the robustness of the results to noise, which is a virtual rise of the setup’s available dynamic range. In fourth place, the environmental sensitivity of millimeter wavelengths issue was approached. It is well known the drifts of electromagnetic experiments due to the dependance of the re sults with respect to the surrounding environment. This feature relegates many industrial practices of microwave frequencies to the experimental stage, at millimeter wavelengths. In particular, evolution of the atmosphere within acceptable conditioning bounds redounds in drift phenomena which completely mask the experimental results. The contribution of this thesis on this aspect consists on modeling electrically the indoor atmosphere existing in a CATR, as a function of environmental variables which affect the range’s performance. A simple model was developed, being able to handle high level phenomena, such as feed - probe phase drift as a function of low level magnitudes easy to be sampled: relative humidity and temperature. With this model, environmental compensation can be performed and chamber conditioning is automatically extended towards higher frequencies. Therefore, the purpose of this thesis is to go further into the knowledge of millimetre wavelengths involving compact antenna test ranges. This knowledge is dosified through the sequential stages of a CATR conception, form early low level electromagnetic analysis towards the assessment of an operative facility, stages for each one of which nowadays bottleneck phenomena exist and seriously compromise the antenna measurement practices at millimeter wavelengths.

Effect of Aspect Ratio on the Three-Dimensional Global Instability Analysis of Incompressible Open Cavity Flows

The stability analysis of open cavity flows is a problem of great interest in the aeronautical industry. This type of flow can appear, for example, in landing gears or auxiliary power unit configurations. Open cavity flows is very sensitive to any change in the configuration, either physical (incoming boundary layer, Reynolds or Mach numbers) or geometrical (length to depth and length to width ratio). In this work, we have focused on the effect of geometry and of the Reynolds number on the stability properties of a threedimensional spanwise periodic cavity flow in the incompressible limit. To that end, BiGlobal analysis is used to investigate the instabilities in this configuration. The basic flow is obtained by the numerical integration of the Navier-Stokes equations with laminar boundary layers imposed upstream. The 3D perturbation, assumed to be periodic in the spanwise direction, is obtained as the solution of the global eigenvalue problem. A parametric study has been performed, analyzing the stability of the flow under variation of the Reynolds number, the L/D ratio of the cavity, and the spanwise wavenumber β. For consistency, multidomain high order numerical schemes have been used in all the computations, either basic flow or eigenvalue problems. The results allow to define the neutral curves in the range of L/D = 1 to L/D = 3. A scaling relating the frequency of the eigenmodes and the length to depth ratio is provided, based on the analysis results.

A generic framework for the analysis and specialization of kogic programs

The relationship between abstract interpretation [2] and partial evaluation [5] has received considerable attention and (partial) integrations have been proposed starting from both the partial deduction (see e.g. [6] and its references) and abstract interpretation perspectives. Abstract interpretation-based analyzers (such as the CiaoPP analyzer [9,4]) generally compute a program analysis graph [1] in order to propagate (abstract) call and success information by performing fixpoint computations when needed. On the other hand, partial deduction methods [7] incorporate powerful techniques for on-line specialization including (concrete) call propagation and unfolding.

Some considerations on the compile-time analysis of constraint logic programs

This paper discusses some issues which arise in the dataflow analysis of constraint logic programming (CLP) languages. The basic technique applied is that of abstract interpretation. First, some types of optimizations possible in a number of CLP systems (including efficient parallelization) are presented and the information that has to be obtained at compile-time in order to be able to implement such optimizations is considered. Two approaches are then proposed and discussed for obtaining this information for a CLP program: one based on an analysis of a CLP metainterpreter using standard Prolog analysis tools, and a second one based on direct analysis of the CLP program. For the second approach an abstract domain which approximates groundness (also referred to as "definiteness") information (i.e. constraint to a single valué) and the related abstraction functions are presented.

Energy Management and Optimization for Video Decoders based on Functional-oriented Reconfiguration

In recent years, the increasing sophistication of embedded multimedia systems and wireless communication technologies has promoted a widespread utilization of video streaming applications. It has been reported in 2013 that youngsters, aged between 13 and 24, spend around 16.7 hours a week watching online video through social media, business websites, and video streaming sites. Video applications have already been blended into people daily life. Traditionally, video streaming research has focused on performance improvement, namely throughput increase and response time reduction. However, most mobile devices are battery-powered, a technology that grows at a much slower pace than either multimedia or hardware developments. Since battery developments cannot satisfy expanding power demand of mobile devices, research interests on video applications technology has attracted more attention to achieve energy-efficient designs. How to efficiently use the limited battery energy budget becomes a major research challenge. In addition, next generation video standards impel to diversification and personalization. Therefore, it is desirable to have mechanisms to implement energy optimizations with greater flexibility and scalability. In this context, the main goal of this dissertation is to find an energy management and optimization mechanism to reduce the energy consumption of video decoders based on the idea of functional-oriented reconfiguration. System battery life is prolonged as the result of a trade-off between energy consumption and video quality. Functional-oriented reconfiguration takes advantage of the similarities among standards to build video decoders reconnecting existing functional units. If a feedback channel from the decoder to the encoder is available, the former can signal the latter changes in either the encoding parameters or the encoding algorithms for energy-saving adaption. The proposed energy optimization and management mechanism is carried out at the decoder end. This mechanism consists of an energy-aware manager, implemented as an additional block of the reconfiguration engine, an energy estimator, integrated into the decoder, and, if available, a feedback channel connected to the encoder end. The energy-aware manager checks the battery level, selects the new decoder description and signals to build a new decoder to the reconfiguration engine. It is worth noting that the analysis of the energy consumption is fundamental for the success of the energy management and optimization mechanism. In this thesis, an energy estimation method driven by platform event monitoring is proposed. In addition, an event filter is suggested to automate the selection of the most appropriate events that affect the energy consumption. At last, a detailed study on the influence of the training data on the model accuracy is presented. The modeling methodology of the energy estimator has been evaluated on different underlying platforms, single-core and multi-core, with different characteristics of workload. All the results show a good accuracy and low on-line computation overhead. The required modifications on the reconfiguration engine to implement the energy-aware manager have been assessed under different scenarios. The results indicate a possibility to lengthen the battery lifetime of the system in two different use-cases.

Human Immunodeficiency Virus Reverse Transcriptase and Protease Sequence Database: an expanded data model integrating natural language text and sequence analysis programs

The HIV Reverse Transcriptase and Protease Sequence Database is an on-line relational database that catalogs evolutionary and drug-related sequence variation in the human immunodeficiency virus (HIV) reverse transcriptase (RT) and protease enzymes, the molecular targets of anti-HIV therapy (http://hivdb.stanford.edu). The database contains a compilation of nearly all published HIV RT and protease sequences, including submissions from International Collaboration databases and sequences published in journal articles. Sequences are linked to data about the source of the sequence sample and the antiretroviral drug treatment history of the individual from whom the isolate was obtained. During the past year 3500 sequences have been added and the data model has been expanded to include drug susceptibility data on sequenced isolates. Database content has also been integrated with didactic text and the output of two sequence analysis programs.

Expert survey on priorities for the information society in the Caribbean

An on-line survey of experts was conducted to solicit their views on policy priorities in the area of information and communication technologies (ICT) in the Caribbean. The experts considered the goal to “promote teacher training in the use of ICTs in the classroom” to be the highest priority, followed by goals to “reduce the cost of broadband services” and “promote the use of ICT in emergency and disaster prevention, preparedness and response.” Goals in the areas of cybercrime, e-commerce, egovernment, universal service funds, consumer protection, and on-line privacy rounded out the top 10. Some of the lowest ranked goals were those related to coordinating the management of infrastructure changes. These included the switchover for digital terrestrial television (DTT) and digital FM radio, cloud computing for government ICT, the introduction of satellite-based internet services, and the installation of content distribution networks (CDNs). Initiatives aimed at using ICT to promote specific industries, or specific means of promoting the digital economy, tended toward the centre of the rankings. Thus, a general pattern emerged which elevated the importance of focusing on how ICT is integrated into the broader society, with economic issues a lower priority, and concerns about coordination on infrastructure issues lower still.

Analysis of the phase behavior of the aqueous poly(ethylene glycol)-Ficoll system

The PEG-Ficoll polymer phase system is one that has been overlooked in the past for biotechnology applications because of the stability of its emulsions. However, new applications, such as emulsion coating of cells, are appearing that rely on this very property. Ficoll is highly polydisperse and multimodal with three distinct Ficoll peaks in gel permeation chromatography. As a result, the transition between one-phase and two-phase systems is blurred and the binodials obtained through turbidometric titration and tie-line analysis differ significantly. Moreover, since the three Ficoll peaks partition differently, tie-line analysis cannot be described by a simple model of the aqueous two-phase system. A simple modification to the model allowed for excellent fit, and this modification may prove well-suited for the many practical cases where aqueous two-phase systems fail to display parallel tie-lines as implicitly assumed in the simpler model.