Clinical use of temporary percutaneous left ventricular assist devices

Temporary percutaneous left ventricular assist devices (TPLVAD) can be inserted and removed in awake patients. They substitute left ventricular function for a period of up to a few weeks and provide an excellent backup and bridge to recovery or decision.

The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study

OBJECTIVES: To map the primary prostatic lymphatic landing sites using a multimodality technique. METHODS: Thirty-four patients with organ-confined prostate cancer (cT1-cT2; cN0) underwent single-photon emission computed tomography fused with data from computed tomography (SPECT/CT) (n=33) or magnetic resonance imaging (SPECT/MRI) (n=1) 1h after ultrasound-guided intraprostatic injection of technecium (Tc-99m) nanocolloid. The presence of lymph nodes (LNs) containing Tc-99m was confirmed intraoperatively with a gamma probe. A backup extended pelvic lymphadenectomy (PLND) was performed to preclude missed primary lymphatic landing sites. The SPECT/CT/MRI data sets were used to generate a three-dimensional projection of each LN site. RESULTS: A total of 317 LNs (median, 10 per patient; range, 3-19) were detected by SPECT/CT/MRI, 314 of which were confirmed by gamma probe. With an "extended" PLND, two thirds of all primary prostatic lymphatic landing sites are resected compared with only one third with a "limited" PLND. CONCLUSIONS: The multimodality technique presented here enables precise mapping of the primary prostatic lymphatic landing sites. PLND for prostate cancer should include not only the external and obturator regions as well as the portions medial and lateral to the internal iliac vessels, but also the common iliac LNs at least up to the ureteric crossing, thus removing approximately 75% of all nodes potentially harbouring metastasis.

Autophagy in cancer and chemotherapy

Cancer cells often exhibit mutations in critical molecules of the apoptotic machinery, resulting in resistance to common anticancer therapies. In the absence of apoptosis, autophagic cell death can be an alternative form of cell death by excessive self-digestion. Therefore, autophagic cell death can be considered as a backup cell death mechanism when apoptotic cell death mechanisms fail. However, many tumors also exhibit deficiencies in autophagy that may result in both genomic instability and further anticancer drug resistance. This chapter summarizes our current understanding regarding the regulation of autophagy in tumors and discusses potential new anticancer drug treatment strategies.

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

BACKGROUND Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. METHODS Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. RESULTS Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. CONCLUSION Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

Chamber evaluation of a personal organic vapor dosimeter at ppb concentrations of VOCs, varying temperatures and humidities with 24 -hour exposures

An exposure system was constructed to evaluate the performance of a personal organic vapor dosimeter (3520 OVM) at ppb concentrations of nine selected target volatile organic compounds (VOCs). These concentration levels are generally encountered in community air environments, both indoor and outdoor. It was demonstrated that the chamber system could provide closely-controlled conditions of VOC concentrations, temperature and relative humidity (RH) required for the experiments. The target experimental conditions included combinations of three VOC concentrations (10, 20 and 200 $\rm\mu g/m\sp3),$ three temperatures (10, 25 and 40$\sp\circ$C) and three RHs (12, 50 and 90% RH), leading to a total of 27 exposure conditions. No backgrounds of target VOCs were found in the exposure chamber system. In the exposure chamber, the variation of the temperature was controlled within $\pm$1$\sp\circ$C, and the variation of RH was controlled within $\pm$1.5% at 12% RH, $\pm$2% at 50% RH and $\pm$3% at 90% RH. High-emission permeation tubes were utilized to generate the target VOCs. Various patterns of the permeation rates were observed over time. The lifetimes and permeation rates of the tubes differed by compound, length of the tube and manufacturer. By carefully selecting the source and length of the tubes, and closely monitoring tube weight loss over time, the permeation tubes can be used for delivering low and stable concentrations of VOCs during multiple days.^ The results of this study indicate that the performance of the 3520 OVM is compound-specific and depends on concentration, temperature and humidity. With the exception of 1,3-butadiene under most conditions, and styrene and methylene chloride at very high relative humidities, recoveries were generally within $\pm$25% of theory, indicating that the 3520 OVM can be effectively used over the range of concentrations and environmental conditions tested with a 24-hour sampling period. Increasing humidities resulted in increasing negative bias from full recovery. Reverse diffusion conducted at 200 $\rm\mu g/m\sp3$ and five temperature/humidity combinations indicated severe diffusion losses only for 1,3-butadiene, methylene chloride and styrene under increased humidity. Overall, the results of this study do not support the need to employ diffusion samplers with backup sections for the exposure conditions tested. ^

Contribución a los modelos de gestión de las redes móviles ad hoc

La capacidad de comunicación de los seres humanos ha crecido gracias a la evolución de dispositivos móviles cada vez más pequeños, manejables, potentes, de mayor autonomía y más asequibles. Esta tendencia muestra que en un futuro próximo cercano cada persona llevaría consigo por lo menos un dispositivo de altas prestaciones. Estos dispositivos tienen incorporados algunas formas de comunicación: red de telefonía, redes inalámbricas, bluetooth, entre otras. Lo que les permite también ser empleados para la configuración de redes móviles Ad Hoc. Las redes móviles Ad Hoc, son redes temporales y autoconfigurables, no necesitan un punto de acceso para que los nodos intercambien información entre sí. Cada nodo realiza las tareas de encaminador cuando sea requerido. Los nodos se pueden mover, cambiando de ubicación a discreción. La autonomía de estos dispositivos depende de las estrategias de como sus recursos son utilizados. De tal forma que los protocolos, algoritmos o modelos deben ser diseñados de forma eficiente para no impactar el rendimiento del dispositivo, siempre buscando un equilibrio entre sobrecarga y usabilidad. Es importante definir una gestión adecuada de estas redes especialmente cuando estén siendo utilizados en escenarios críticos como los de emergencias, desastres naturales, conflictos bélicos. La presente tesis doctoral muestra una solución eficiente para la gestión de redes móviles Ad Hoc. La solución contempla dos componentes principales: la definición de un modelo de gestión para redes móviles de alta disponibilidad y la creación de un protocolo de enrutamiento jerárquico asociado al modelo. El modelo de gestión propuesto, denominado High Availability Management Ad Hoc Network (HAMAN), es definido en una estructura de cuatro niveles, acceso, distribución, inteligencia e infraestructura. Además se describen los componentes de cada nivel: tipos de nodos, protocolos y funcionamiento. Se estudian también las interfaces de comunicación entre cada componente y la relación de estas con los niveles definidos. Como parte del modelo se diseña el protocolo de enrutamiento Ad Hoc, denominado Backup Cluster Head Protocol (BCHP), que utiliza como estrategia de encaminamiento el empleo de cluster y jerarquías. Cada cluster tiene un Jefe de Cluster que concentra la información de enrutamiento y de gestión y la envía al destino cuando esta fuera de su área de cobertura. Para mejorar la disponibilidad de la red el protocolo utiliza un Jefe de Cluster de Respaldo el que asume las funciones del nodo principal del cluster cuando este tiene un problema. El modelo HAMAN es validado a través de un proceso la simulación del protocolo BCHP. El protocolo BCHP se implementa en la herramienta Network Simulator 2 (NS2) para ser simulado, comparado y contrastado con el protocolo de enrutamiento jerárquico Cluster Based Routing Protocol (CBRP) y con el protocolo de enrutamiento Ad Hoc reactivo denominado Ad Hoc On Demand Distance Vector Routing (AODV). Abstract The communication skills of humans has grown thanks to the evolution of mobile devices become smaller, manageable, powerful, more autonomy and more affordable. This trend shows that in the near future each person will carry at least one high-performance device. These high-performance devices have some forms of communication incorporated: telephony network, wireless networks, bluetooth, among others. What can also be used for configuring mobile Ad Hoc networks. Ad Hoc mobile networks, are temporary and self-configuring networks, do not need an access point for exchange information between their nodes. Each node performs the router tasks as required. The nodes can move, change location at will. The autonomy of these devices depends on the strategies of how its resources are used. So that the protocols, algorithms or models should be designed to efficiently without impacting device performance seeking a balance between overhead and usability. It is important to define appropriate management of these networks, especially when being used in critical scenarios such as emergencies, natural disasters, wars. The present research shows an efficient solution for managing mobile ad hoc networks. The solution comprises two main components: the definition of a management model for highly available mobile networks and the creation of a hierarchical routing protocol associated with the model. The proposed management model, called High Availability Management Ad Hoc Network (HAMAN) is defined in a four-level structure: access, distribution, intelligence and infrastructure. The components of each level: types of nodes, protocols, structure of a node are shown and detailed. It also explores the communication interfaces between each component and the relationship of these with the levels defined. The Ad Hoc routing protocol proposed, called Backup Cluster Head Protocol( BCHP), use of cluster and hierarchies like strategies. Each cluster has a cluster head which concentrates the routing information and management and sent to the destination when out of cluster coverage area. To improve the availability of the network protocol uses a Backup Cluster Head who assumes the functions of the node of the cluster when it has a problem. The HAMAN model is validated accross the simulation of their BCHP routing protocol. BCHP protocol has been implemented in the simulation tool Network Simulator 2 (NS2) to be simulated, compared and contrasted with a hierarchical routing protocol Cluster Based Routing Protocol (CBRP) and a routing protocol called Reactive Ad Hoc On Demand Distance Vector Routing (AODV).

Improving availability of mobile networks using a cluster routing protocol with redundant cluster head

We show a cluster based routing protocol in order to improve the convergence of the clusters and of the network it is proposed to use a backup cluster head. The use of a event discrete simulator is used for the implementation and the simulation of a hierarchical routing protocol called the Backup Cluster Head Protocol (BCHP). Finally it is shown that the BCHP protocol improves the convergence and availability of the network through a comparative analysis with the Ad Hoc On Demand Distance Vector (AODV)[1] routing protocol and Cluster Based Routing Protocol (CBRP)[2]

CPV hybrid system in ISFOC building, first results

PV Off-Grid systems have demonstrated to be a good solution for the electrification of remote areas [1]. A hybrid system is one kind of these systems. The principal characteristic is that it uses PV as the main generator and has a backup power supply, like a diesel generator, for instance, that is used when the CPV generation is not enough to meet demand. To study the use of CPV in these systems, ISFOC has installed a demonstration hybrid system at its headquarters. This hybrid system uses CPV technology as main generator and the utility grid as the backup generator. A group of batteries have been mounted as well to store the remaining energy from the CPV generator when nedeed. The energy flows are managed by a SMA system based on Sunny Island inverters and a Multicluster-Box (figure 1). The Load is the air-conditioning system of the building, as it has a consumption profile higher than the CPV generator and can be controlled by software [2]. The first results of this system, as well as the first chances of improvement, as the need of a bigger CPV generator and a better management of the energy stored in the batteries, are presented in this paper.

Desarrollo de una plataforma de servicios gestionados para soluciones de contingencia en el Cloud

La proliferación en todo el mundo de las soluciones basadas en la nube hace que las empresas estén valorando mover su infraestructura o parte de ella a la nube, para así reducir los altos costes de inversión necesarios para mantener una infraestructura privada. Uno de los servicios que puede ser centralizado en la nube, mediante recursos compartidos entre varios clientes, son las soluciones de contingencia, como los servicios de protección de datos o los centros de recuperación ante desastres. Mediante este proyecto se pretende llevar a cabo el despliegue de una plataforma de servicios gestionados para ofrecer soluciones centralizadas, a clientes que lo requieran, de copias de seguridad y disaster recovery. Para la realización del proyecto se realizó un estudio de las tecnologías actuales para llevar a cabo la continuidad de negocio, los distintos tipos de backups, así como los tipos de replicación existente, local y remota. Posteriormente, se llevó a cabo un estudio de mercado para barajar las distintas posibilidades existentes para el despliegue de la infraestructura, siempre teniendo en cuenta el cliente objetivo. Finalmente, se realizó la fase de desarrollo, donde se detallan los componentes principales que componen la solución final, la localización de la infraestructura, un caso de uso, así como las principales ventajas de la solución. Se ha de destacar que se trata de un proyecto real, que se llevó a cabo en una empresa externa a la facultad, Omega Peripherals, donde una vez finalizado mi prácticum, se propuso dicho proyecto para desarrollarlo como continuación de mi labor en la empresa y formar parte de mi Trabajo Final de Grado (TFG). ---ABSTRACT---The worldwide proliferation of cloud-based solutions means that companies are evaluating their infrastructure or move part of it to the cloud, to reduce the high investment costs required to maintain a private infrastructure. One of the services that can be centralized in the cloud, through shared resources between multiple clients, are the solutions of contingency services as data protection or disaster recovery centers. This project aims to carry out the deployment of a managed services platform centralized solutions, to customers who need it, backup and disaster recovery services. The project consists of three phases. First, It was performed a study of the current business continuity technologies, the different types of backups, as well as replication types, local and remote. Second, it was performed a market study to shuffle the different possibilities for the deployment of infrastructure, keeping in mind the target customer. Finally, we found the development phase, where it details the main components that make up the final solution, the location of infrastructure, a use case, as well as the main advantages of the solution. It should be emphasized that this is a real project, which was carried out in an outside company to the university, called Omega Peripherals, where once I completed my practicum, it was proposed this project to develop it as a continuation of my job and develop it as my final dissertation.

Instituto de Sistemas Fotovoltaicos de Concentración concentration photovoltaics hybrid system first year of operation and improvements

A photovoltaic (PV) hybrid system combines PV with other forms of electricity generation, usually a diesel generator. The system presented in this paper uses concentration photovoltaic (CPV) as the main generator in combination with a storage system and the grid, configured as the backup power supply. The load of the system consists of an air conditioning system of an office building. This paper presents the results obtained from the first months of operation of the CPV hybrid system installed at Instituto de Sistemas Fotovoltaicos de Concentración facilities together with exhaustive simulations in order to model the system behaviour and be able to improve the self-consumption ratio. This system represents a first approach to the use of a CPV in office buildings complemented by an existing AC-coupled hybrid system. The contribution of this paper to the analysis of this new system and the existing tools available for its simulation, at least a part of it, can be considered as a starting point for the development of these kinds of systems.

State of the Art and Future Trends in Grid Codes Applicable to Isolated Electrical Systems

Isolated electrical systems lack electrical interconnection to other networks and are usually placed in geographically isolated areas—mainly islands or locations in developing countries. Until recently, only diesel generators were able to assure a safe and reliable supply in exchange for very high costs for fuel transportation and system operation. Transmission system operators (TSOs) are increasingly seeking to replace traditional energy models based on large groups of conventional generation units with mixed solutions where diesel groups are held as backup generation and important advantages are provided by renewable energy sources. The grid codes determine the technical requirements to be fulfilled by the generators connected in any electrical network, but regulations applied to isolated grids are more demanding. In technical literature it is rather easy to find and compare grid codes for interconnected electrical systems. However, the existing literature is incomplete and sparse regarding isolated grids. This paper aims to review the current state of isolated systems and grid codes applicable to them, specifying points of comparison and defining the guidelines to be followed by the upcoming regulations.

Virtualización de laboratorios

Para empezar, se ha hecho un análisis de las diferentes posibilidades que se podían implementar para poder conseguir el objetivo del trabajo. El resultado final debe ser, disponer de máquinas para que el sistema operativo fuese independiente del hardware que se tiene instalado en él . Para ello, se decide montar un sistema operativo de base en todos los equipos del laboratorio, que tenga las necesidades mínimas que se necesitan, las cuales son una interfaz gráfica y conexión de red. Hay que intentar reducir el consumo de recursos al máximo con este sistema operativo mínimo para que el rendimiento de las máquinas sea lo más fluido posible para los usuarios. El sistema elegido fue Linux con su distribución Ubuntu [ubu, http] con los módulos mínimos que permita funcionar el software necesario. Una vez se instala el sistema operativo anfitrión, se instala el escritorio Xfce [ubu2, http], que es el más ligero de Ubuntu, pero que proporciona buen rendimiento. Después, se procedió a instalar un software de virtualización en cada equipo. En este caso se decidió, por las buenas prestaciones que ofrecía, que fuera VirtualBox [vir2,http] de Oracle. Sobre éste software se crean tantas máquinas virtuales (con sistema operativo Windows) como asignaturas diferentes se cursan en el laboratorio donde se trabaje. Con esto, se consigue que al arrancar el programa los alumnos pudieran escoger qué máquina arrancar y lo que es más importante, se permite realizar cualquier cambio en el hardware (exceptuando el disco duro porque borraría todo lo que se tuviera guardado). Además de no tener que volver a reinstalar el sistema operativo nuevamente, se consigue la abstracción del software y hardware. También se decide que, para tener un respaldo de las máquinas virtuales que se tengan creadas en VirtualBox, se utiliza un servidor NAS. Uno de los motivos de utilizar dicho servidor fue por aprovechar una infraestructura ya creada. Un servidor NAS da la posibilidad de recuperar cualquier archivo (máquina virtual) cuando haga falta porque haya alguna máquina virtual corrupta en algún equipo, o en varios. Este tipo de servidor tiene la gran ventaja de ser multicast, es decir, permite solicitudes simultáneas. ABSTRACT For starters, there has been an analysis of the different possibilities that could be implemented to achieve the objective of the work. This objective was to have machines for the operating system to be independent of the hardware we have installed on it. Therefore, we decided to create an operating system based on all computers in the laboratory, taking the minimum needs we need. This is a graphical interface and network connection. We must try to reduce the consumption of resources to the maximum for the performance of the machines is as fluid as possible for users. The system was chosen with its Ubuntu Linux distribution with minimum modules that allow us to run software that is necessary for us. Once the base is installed, we install the Xfce desktop, which is the lightest of Ubuntu, but which provided good performance. Then we proceeded to install a virtualization software on each computer. In this case we decided, for good performance that gave us, it was Oracle VirtualBox. About this software create many virtual machines (Windows operating system) as different subjects are studied in the laboratory where we are. With that, we got it at program startup students could choose which machine start and what is more important, allowed us to make any changes to the hardware (except the hard drive because it would erase all we have). Besides not having to reinstall the operating system again, we get the software and hardware abstraction. We also decided that in order to have a backup of our virtual machines that we created in VirtualBox, we use a NAS server. One reason to use that server was to leverage their existing network infrastructure. A NAS server gives us the ability to retrieve any file (image) when we do need because there is some corrupt virtual machine in a team, or several. This is possible because this type of server allows multicast connection.

2.7 Lincoln University Senior Class of 1935

After graduation, Lloyd Gaines filed papers with placement office at Lincoln but he could not find an immediate position. Although he minored in education, Gaines was not primarily searching for a teaching position. However, he had a backup plan. Lloyd's background in history led him to an interest in the law and unbeknownst to anyone, save his mentor, Lorenzo Greene, he was preparing to what no American-American had done before. Lloyd Gaines was going to enroll in the University Missouri School of Law.

A Mea Culpa for The Felix Culpa? A Greater Goods Response to the Problems of Evil and Hell

In this paper I want to develop a particular kind of greater-good response to the problems of evil and hell, one which hence can serve as a backup plan should the free will defense not satisfy. Ultimately, this response will appear to belong to several traditions in theodicy. Like all greater-goods views, this one relies on explaining the existence of evil in terms of the greater goods that come out of it. Among these goods are the greater goods of Incarnation and Atonement, their respective goodness consisting in large part in the higher-order divine good of glorifying God through the display of divine virtue.

Abnormal photoresponses and light-induced apoptosis in rods lacking rhodopsin kinase

Phosphorylation is thought to be an essential first step in the prompt deactivation of photoexcited rhodopsin. In vitro, the phosphorylation can be catalyzed either by rhodopsin kinase (RK) or by protein kinase C (PKC). To investigate the specific role of RK, we inactivated both alleles of the RK gene in mice. This eliminated the light-dependent phosphorylation of rhodopsin and caused the single-photon response to become larger and longer lasting than normal. These results demonstrate that RK is required for normal rhodopsin deactivation. When the photon responses of RK−/− rods did finally turn off, they did so abruptly and stochastically, revealing a first-order backup mechanism for rhodopsin deactivation. The rod outer segments of RK−/− mice raised in 12-hr cyclic illumination were 50% shorter than those of normal (RK+/+) rods or rods from RK−/− mice raised in constant darkness. One day of constant light caused the rods in the RK−/− mouse retina to undergo apoptotic degeneration. Mice lacking RK provide a valuable model for the study of Oguchi disease, a human RK deficiency that causes congenital stationary night blindness.