Patient-specific anisotropic model of human trunk based on MR data

There are many ways to generate geometrical models for numerical simulation, and most of them start with a segmentation step to extract the boundaries of the regions of interest. This paper presents an algorithm to generate a patient-specific three-dimensional geometric model, based on a tetrahedral mesh, without an initial extraction of contours from the volumetric data. Using the information directly available in the data, such as gray levels, we built a metric to drive a mesh adaptation process. The metric is used to specify the size and orientation of the tetrahedral elements everywhere in the mesh. Our method, which produces anisotropic meshes, gives good results with synthetic and real MRI data. The resulting model quality has been evaluated qualitatively and quantitatively by comparing it with an analytical solution and with a segmentation made by an expert. Results show that our method gives, in 90% of the cases, as good or better meshes as a similar isotropic method, based on the accuracy of the volume reconstruction for a given mesh size. Moreover, a comparison of the Hausdorff distances between adapted meshes of both methods and ground-truth volumes shows that our method decreases reconstruction errors faster. Copyright © 2015 John Wiley & Sons, Ltd.

Stressors and turning points in high school and dropout : a stress process, life course framework

High school dropout is commonly seen as the result of a long-term process of failure and disengagement. As useful as it is, this view has obscured the heterogeneity of pathways leading to dropout. Research suggests, for instance, that some students leave school not as a result of protracted difficulties but in response to situations that emerge late in their schooling careers, such as health problems or severe peer victimization. Conversely, others with a history of early difficulties persevere when their circumstances improve during high school. Thus, an adequate understanding of why and when students drop out requires a consideration of both long-term vulnerabilities and proximal disruptive events and contingencies. The goal of this review is to integrate long-term and immediate determinants of dropout by proposing a stress process, life course model of dropout. This model is also helpful for understanding how the determinants of dropout vary across socioeconomic conditions and geographical and historical contexts.

Bindung und Dropout im Nachwuchsleistungssport

Jede sportliche Karriere ist durch eine Vielzahl von Entscheidungen geprägt. Während sich ein Teil dieser Entscheidungsprozesse nur geringfügig auf den Karriereverlauf auswirkt, können andere diesen massiv beeinflussen. In den meisten Fällen begründet sich ein vorzeitiger Ausstieg nicht auf der Grundlage eines akuten Ereignisses, sondern lässt sich aus langfristigen Bilanzierungsprozessen, in denen Kosten und Nutzen des leistungssportlichen Engagements gegenüber gestellt werden, ableiten. Welche der Gründe eine solche Entscheidung maßgeblich beeinflussen, kann jedoch nicht mit aller Sicherheit gesagt werden. Diese Tatsache begründet sich vor Allem über die in diesem Forschungsfeld bisher meist sportartspezifisch ausgerichteten Untersuchungen. Neben den Begründungen, die zum Karriereabbruch führen, interessieren zudem die Athleten, die langfristig im Fördersystem aktiv sind. Wie unterscheiden sie sich von den Aussteigern und welche Strategien verfolgen sie, um den Anforderungen aus den unterschiedlichen Lebensbereichen gerecht werden zu können? Die Studie versucht die Frage nach karrierebeeinflussenden Merkmalen auf der Grundlage eines theoretisch abgeleiteten Analysemodells aus der Sicht der Athleten sportartübergreifend zu bearbeiten und legt hierbei den Fokus vor allem auf die Rahmen- und Umweltbedingungen der leistungssportlich trainierenden Athleten. Ausgangspunkt des entwickelten Untersuchungsmodells sind die Überlegungen von Mayntz und Scharpf zum akteurzentrierten Institutionalismus. Demnach muss eine umfassende Betrachtung von Entscheidungen im Karriereverlauf junger Nachwuchsathleten neben systemischen Fragen vor allem über die Interaktionen der am Förderprozess beteiligten Personengruppen geführt werden. Das längsschnittlich angelegte Untersuchungsdesign soll einerseits ermöglichen, den vorzeitigen Karriereabbruch aufgrund der Veränderungen in der Bewertung der Einflussfaktoren im Karriereverlauf zu erklären, andererseits soll über die retrospektive Betrachtung der Antworten zum ersten Messzeitpunkt überprüft werden, ob sich die Aussteiger und Fortsetzer bereits im Vorfeld anhand zentraler Variablen unterscheiden lassen. Hinsichtlich der Untersuchungsgruppen zeigte sich, dass zwischen den Aussteigern und den Fortsetzern eine Reihe von signifikanten Unterschieden festgestellt werden konnte. Vor allem dem Erwerb von Strategien zur Bewältigung der Anforderungen aus der Verbindung von Leistungssport mit den weiteren Lebensbereichen der Athleten ist in der Gruppe der Fortsetzer deutlich höher ausgeprägt, wenngleich diese Athleten auch angeben, mit höheren Belastungen umgehen zu müssen. Es ist anzunehmen, dass diese in der Auseinandersetzung erworbenen Kompetenzen im Sinne des Transfers auf sportliche Situationen übertragen werden können und zu einer für die Athleten zufriedenstellenderen Bewältigung beitragen.

A study of physicians' intention to quit : The role of burnout, commitment and difficult doctor-patient interactions

Resumen tomado de la publicaci??n

Youth sport dropout from the achievement goal theory. 'El abandono del deporte en j??venes desde la Teor??a de las metas de logro'

Resumen tomado de la publicaci??n. Resumen tambi??n en ingl??s

Locomotor Virtual Patient Scene

BM1 Locomotor Virtual Patient screenshot

Year 1 Virtual Patient Screen Capture file

Screen capture used for MedB & VP conference 2010

ALPS Workshop 4 p17 Patient safety

Accordion animation

The differential effect on dropout of increasing grades' supply by integrating or expanding schools: evidence from a quasi-experiment in Bogotá

En el año 2002, la Secretaría de Educación de Bogotá estipuló la Resolución 2101 que tenía por objeto asegurar el ciclo de la educación completo en los colegios públicos. El propósito de este trabajo es evaluar el impacto de los mecanismos seguidos a la aplicación de esta política sobre la tasa de deserción escolar. Las escuelas tenían tres mecanismos diferentes para alcanzar el objetivo de la presente resolución: expandir los grados escolares ofertados, integrarse con otros colegios de la zona, o ambos. Para ello, utilizo variables instrumentales para resolver el sesgo causado por el hecho de que los colegios que siguen determinada estrategia eran los que tenían altas tasas de deserción inicialmente. Usando datos sobre las características institucionales y las características socio-demográficas de la población cerca del colegio, evalúo el impacto de estos tres mecanismos sobre las tasas de deserción escolar. Los resultados sugieren que las instituciones que aumentaron los grados experimentan un aumento en el número de estudiantes que abandonan el colegio en 12.1 puntos porcentuales, mientras que las instituciones que complementaron este mecanismo con la integración de un colegio próximo pre existente mostraron una reducción en la tasa de deserción escolar de 9.8 puntos porcentuales.

Effects of pulmonary rehabilitation program in a patient with severe asthma diagnosis

Objective: to present the effectiveness of pulmonary rehabilitation programs in the treatmentof a patient with asthma, this is the case of a young Caucasian girl —17 years old— with severe asthma diagnosis, with symptoms since she was eight years old, 10th grade student. Method: She was referred to the program of Pulmonary Rehabilitation after three hospitalizations during the last year due to asthmatic crises, dyspnoea in activities of daily living, and intolerance to physical exercise. In the initial evaluation, a patient with non-controlled asthma was found; she was receiving short-acting medication admitting that she was not complying with regular use and with a prescribed dose of the pharmacological treatment and that she ignored the importance of this commitment for optimal evolution. The patient expressed concern about the progressive deterioration at her respiratory and functional level during the last year and her fear and anxiety for not being able to breathe during activities befitting her age. Results: One month after receiving bronchodilators and long-acting steroids permanently and complying with recommendations about regular use and adequate inhalatory technique, the patient was included in a three-times a-week program of pulmonary rehabilitation during eight weeks for upper and lower extremity endurance and resistance training. Conclusion: This intervention showed significant changes in the patient at functional level and a greater social participation.

The amputee patient: complications of its process of rehabilitation

This article is centered in the presentation of the complications that can be given in the stump of an amputated patient, considering the context of the phases and the stages of the rehabilitation process through which it must pass this type of patient. Also, the boarding of this subject is framed specially in one of the main causes of amputation in the world and in a country like Colombia that for years has been submerged in a special situation of violence. It also defines different strategies from intervention for the mentioned complications and makes it relevant the necessity of a team of rehabilitation for the treatment of these patients, concluding with the importance that has the inclusion of the patient to its occupational, social and familiar roll, to really complete the rehabilitation process. It also defines different strategies from intervention for the mentioned complications and makes it relevant the necessity of an interdisciplinary rehabilitation team for the treatment of these patients. To finish with the part of the process in witch the patient returns back to its working, social and familiar roll.

Prediction of postprandial blood glucose under intra-patient variability and uncertainty and its use in the design of insulin dosing strategies for type 1 diabetic patients

In this thesis I propose a novel method to estimate the dose and injection-to-meal time for low-risk intensive insulin therapy. This dosage-aid system uses an optimization algorithm to determine the insulin dose and injection-to-meal time that minimizes the risk of postprandial hyper- and hypoglycaemia in type 1 diabetic patients. To this end, the algorithm applies a methodology that quantifies the risk of experiencing different grades of hypo- or hyperglycaemia in the postprandial state induced by insulin therapy according to an individual patient’s parameters. This methodology is based on modal interval analysis (MIA). Applying MIA, the postprandial glucose level is predicted with consideration of intra-patient variability and other sources of uncertainty. A worst-case approach is then used to calculate the risk index. In this way, a safer prediction of possible hyper- and hypoglycaemic episodes induced by the insulin therapy tested can be calculated in terms of these uncertainties.

Hearing screening with otoacoustic emissions and patient age in a pediatrician's practice

This paper presents a study of the effectiveness of a neonatal hearing screener (the GSI AUDIOscreener, which is usually used in hospitals to test newborns), in a pediatrician's offices to test infants and children up to age 5-1/2 years.

A comparison of the QuickSIN and TEN tests: two recent tests designed to predict patient benefit from high frequency amplification

This paper presents a comparison of two tests designed to predict which hearing impaired patients may benefit from high frequency amplification.

Patient perception of disability following acoustic (vestibular) schwannoma removal via gamma knife and microsurgical techniques

This study evaluates patient's short and long-term balance function after microsurgical tumor removal and gamma knife radiosurgery using an unvalidated qualitative questionnaire and the Dizziness Handicap Inventory.