Appropriateness of colonoscopy in Europe (EPAGE II). Chronic diarrhea and known inflammatory bowel disease.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for investigation of chronic diarrhea, management of patients with known inflammatory bowel disease (IBD), and for colorectal cancer (CRC) surveillance in such patients, and to report report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews, and primary studies regarding the evaluation of chronic diarrhea, the management of IBD, and colorectal cancer surveillance in IBD was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: According to the literature, colonoscopic evaluation may be justified for patients aged > 50 years with recent-onset chronic diarrhea or with alarm symptoms. Surveillance colonoscopy for CRC should be offered to all patients with extensive ulcerative colitis or colonic Crohn's disease of 8 years' duration, and to all patients with less extensive disease of 15 years' duration. Intervals for surveillance colonoscopy depend on duration of evolution, initial diagnosis, and histological findings. The EPAGE II criteria also confirmed the appropriateness of diagnostic colonoscopy for diarrhea of > 4 weeks' duration. They also suggest that, in addition to assessing extent of IBD by colonoscopy, further colonoscopic examination is appropriate in the face of persistent or worsening symptoms. Surveillance colonoscopy in IBD patients was generally appropriate after a lapse of 2 years. In the presence of dysplasia at previous colonoscopy, it was not only appropriate but necessary. CONCLUSIONS: Despite or perhaps because of the limitations of the available published studies, the panel-based EPAGE II (http://www.epage.ch) criteria can help guide appropriate colonoscopy use in the absence of strong evidence from the literature.

Performance of mechanical ventilators at the patient's home: a multicentric quality control study

Background: Quality control procedures vary considerably among the providers of equipment for home mechanical ventilation (HMV). Methods: A multicentre quality control survey of HMV was performed at the home of 300 patients included in the HMV programmes of four hospitals in Barcelona. It consisted of three steps: (1) the prescribed ventilation settings, the actual settings in the ventilator control panel, and the actual performance of the ventilator measured at home were compared; (2) the different ventilator alarms were tested; and (3) the effect of differences between the prescribed settings and the actual performance of the ventilator on non-programmed readmissions of the patient was determined. Results: Considerable differences were found between actual, set, and prescribed values of ventilator variables; these differences were similar in volume and pressure preset ventilators. The percentage of patients with a discrepancy between the prescribed and actual measured main ventilator variable (minute ventilation or inspiratory pressure) of more than 20% and 30% was 13% and 4%, respectively. The number of ventilators with built in alarms for power off, disconnection, or obstruction was 225, 280 and 157, respectively. These alarms did not work in two (0.9%), 52 (18.6%) and eight (5.1%) ventilators, respectively. The number of non-programmed hospital readmissions in the year before the study did not correlate with the index of ventilator error. Conclusions: This study illustrates the current limitations of the quality control of HMV and suggests that improvements should be made to ensure adequate ventilator settings and correct ventilator performance and ventilator alarm operation.

Method to assess and optimise dependability of complex macro-systems: application to a railway signalling system

Achieving a high degree of dependability in complex macro-systems is challenging. Because of the large number of components and numerous independent teams involved, an overview of the global system performance is usually lacking to support both design and operation adequately. A functional failure mode, effects and criticality analysis (FMECA) approach is proposed to address the dependability optimisation of large and complex systems. The basic inductive model FMECA has been enriched to include considerations such as operational procedures, alarm systems. environmental and human factors, as well as operation in degraded mode. Its implementation on a commercial software tool allows an active linking between the functional layers of the system and facilitates data processing and retrieval, which enables to contribute actively to the system optimisation. The proposed methodology has been applied to optimise dependability in a railway signalling system. Signalling systems are typical example of large complex systems made of multiple hierarchical layers. The proposed approach appears appropriate to assess the global risk- and availability-level of the system as well as to identify its vulnerabilities. This enriched-FMECA approach enables to overcome some of the limitations and pitfalls previously reported with classical FMECA approaches.

False recognition following frontal lobe damage: The role of encoding factors

This paper reports a series of experiments on patient JB, a man with memory difficulties following damage to the left frontal lobe. The primary characteristic of JB's recognition memory impairment is a high level of false recognition together with a normal hit rate. The hypothesis that JB's false recognition reflects an over-reliance on familiarity is considered, but discounted on the basis that the false alarm rate is not affected by increasing the similarity between distracters and targets, and remains high when nonword stimuli are used. It is suggested, instead, that JB relies on a poorly focused memory description, which lacks item-specific detail but contains more general, low-level properties of the target items-these properties being held by many distracter items as well. This deficit is considered to arise because of damage to frontally mediated control processes involved in the selection of elements for memory encoding. An encoding deficit is supported by the fact that JB's false recognition is significantly reduced by orienting instructions, and is eliminated when his remote memory is subjected to recognition testing. In contrast, it is shown that manipulations at the level of retrieval (e.g. restricting the number of "old" responses) have little effect on his false recognition.

The Iowa State Capitol Fire 1904, November 2012

The twenty-first century Iowa State Capitol contains state-of-the-art fire protection. Sprinklers and smoke detectors are located in every room and all public hallways are equipped with nearby hydrants. The Des Moines Fire Department is able to fight fires at nearly any height. However, on Monday morning, January 4, 1904, the circumstances were much different. By the beginning of 1904, the Capitol Improvement Commission had been working in the Capitol for about two years. The commissioners were in charge of decorating the public areas of the building, installing the artwork in the public areas, installing a new copper roof, re-gilding the dome, replacing windows, and connecting electrical lines throughout. Electrician H. Frazer had been working that morning in Committee Room Number Five behind the House Chamber, drilling into the walls to run electrical wires and using a candle to light his way. The investigating committee determined that Frazer had left his work area and had neglected to extinguish his candle. The initial fire alarm sounded at approximately 10 a.m. Many citizen volunteers came to help the fire department. Capitol employees and state officials also assisted in fighting the fire, including Governor Albert Cummins. The fire was finally brought under control around 6 p.m., although some newspaper accounts at the time reported that the fire continued smoldering for several days. Crampton Linley was the engineer working with the Capitol Improvement Commission. He was in the building at the time of the fire and was credited with saving the building. Linley crawled through attic areas to close doors separating wings of the Capitol, an action which smothered the flames and brought the fire under control. Sadly, Linley did not live long enough to be recognized for his heroism. The day after the fire, while examining the damage, Linley fell through the ceiling of the House Chamber and died instantly from severe head injuries. The flames had burned through the ceiling and caused much of it to collapse to the floor below, while the lower areas of the building had been damaged by smoke and water. Elmer Garnsey was the artist hired by the Capitol Improvement Commission to decorate the public areas of the building. Therefore, he seemed the logical candidate to be given the additional responsibility of redecorating the areas damaged by the fire. Garnsey had a very different vision for the decoration, which is why the House Chamber, the old Supreme Court Room, and the old Agriculture offices directly below the House Chamber have a design that is very different from the areas of the building untouched by the fire.

Evaluation of the user-friendliness of seven new generation intensive care ventilators.

OBJECTIVE: To explore the user-friendliness and ergonomics of seven new generation intensive care ventilators. DESIGN: Prospective task-performing study. SETTING: Intensive care research laboratory, university hospital. METHODS: Ten physicians experienced in mechanical ventilation, but without prior knowledge of the ventilators, were asked to perform eight specific tasks [turning the ventilator on; recognizing mode and parameters; recognizing and setting alarms; mode change; finding and activating the pre-oxygenation function; pressure support setting; stand-by; finding and activating non-invasive ventilation (NIV) mode]. The time needed for each task was compared to a reference time (by trained physiotherapist familiar with the devices). A time >180 s was considered a task failure. RESULTS: For each of the tests on the ventilators, all physicians' times were significantly higher than the reference time (P < 0.001). A mean of 13 +/- 8 task failures (16%) was observed by the ventilator. The most frequently failed tasks were mode and parameter recognition, starting pressure support and finding the NIV mode. Least often failed tasks were turning on the pre-oxygenation function and alarm recognition and management. Overall, there was substantial heterogeneity between machines, some exhibiting better user-friendliness than others for certain tasks, but no ventilator was clearly better that the others on all points tested. CONCLUSIONS: The present study adds to the available literature outlining the ergonomic shortcomings of mechanical ventilators. These results suggest that closer ties between end-users and manufacturers should be promoted, at an early development phase of these machines, based on the scientific evaluation of the cognitive processes involved by users in the clinical setting.

Comparing 'visual' effect size indices for single-case designs

Effect size indices are indispensable for carrying out meta-analyses and can also be seen as an alternative for making decisions about the effectiveness of a treatment in an individual applied study. The desirable features of the procedures for quantifying the magnitude of intervention effect include educational/clinical meaningfulness, calculus easiness, insensitivity to autocorrelation, low false alarm and low miss rates. Three effect size indices related to visual analysis are compared according to the aforementioned criteria. The comparison is made by means of data sets with known parameters: degree of serial dependence, presence or absence of general trend, changes in level and/or in slope. The percent of nonoverlapping data showed the highest discrimination between data sets with and without intervention effect. In cases when autocorrelation or trend is present, the percentage of data points exceeding the median may be a better option to quantify the effectiveness of a psychological treatment.

Factors affecting visual analysis in single-case designs

Visual inspection remains the most frequently applied method for detecting treatment effects in single-case designs. The advantages and limitations of visual inference are here discussed in relation to other procedures for assessing intervention effectiveness. The first part of the paper reviews previous research on visual analysis, paying special attention to the validation of visual analysts" decisions, inter-judge agreement, and false alarm and omission rates. The most relevant factors affecting visual inspection (i.e., effect size, autocorrelation, data variability, and analysts" expertise) are highlighted and incorporated into an empirical simulation study with the aim of providing further evidence about the reliability of visual analysis. Our results concur with previous studies that have reported the relationship between serial dependence and increased Type I rates. Participants with greater experience appeared to be more conservative and used more consistent criteria when assessing graphed data. Nonetheless, the decisions made by both professionals and students did not match sufficiently the simulated data features, and we also found low intra-judge agreement, thus suggesting that visual inspection should be complemented by other methods when assessing treatment effectiveness.

Appropriateness of colonoscopy in Europe (EPAGE II). Functional bowel disorders: pain, constipation and bloating.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of functional bowel symptoms, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of functional bowel symptoms was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: Much of the evidence for use of colonoscopy in evaluation of chronic abdominal pain, and/or constipation and/or abdominal bloating is modest. Major limitations include small numbers of patients and lack of adequate characterization of these patients. Large community-based follow-up studies are needed to enable better definition of the natural history of patients with functional bowel disorders. Guidelines stress that alarm features ("red flags"), such as rectal bleeding, anemia, weight loss, nocturnal symptoms, family history of colon cancer, age of onset > 50 years, and recent onset of symptoms should all lead to careful evaluation before a diagnosis of functional bowel disorder is made. EPAGE II assessed these symptoms by means of 12 clinical scenarios, rating colonoscopy as appropriate, uncertain and inappropriate in 42 % (5/12), 25 % (3/12), and 33 % (4/12) of these, respectively. CONCLUSIONS: Evidence to support the use of colonoscopy in the evaluation of patients with functional bowel disorders and no alarm features is lacking. These patients have no increased risk of colon cancer and thus advice on screening for this is not different from that for the general population. EPAGE II criteria, available online (http://www.epage.ch), consider colonoscopy appropriate in patients of > 50 years with chronic or new-onset bowel disturbances, but not in patients with isolated chronic abdominal pain.

Gestión de mecanismos Arduino controlados inalámbricamente por dispositivos Android

El objetivo de este proyecto es el de realizar la fabricación de una alarma la cual se puede controlar desde cualquier dispositivo Android, ya que la comunicación se realiza a través de la conexión Bluetooth entre una aplicación Android y una placa Arduino que realiza el control del mecanismo Hardware. A través de la aplicación que se instala en el dispositivo móvil, se puede realitzar el control del prototipo, como la validación del usuario, activación y desactivación de la alarma y enlazar con el módulo Bluetooth.

Appropriateness of colonoscopy in Europe (EPAGE II). Iron-deficiency anemia and hematochezia.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of iron-deficiency anemia (IDA) and hematochezia, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of IDA and hematochezia was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: IDA occurs in 2 %-5 % of adult men and postmenopausal women. Examination of both the upper and lower gastrointestinal tract is recommended in patients with iron deficiency. Colonoscopy for IDA yields one colorectal cancer (CRC) in every 9-13 colonoscopies. Hematochezia is a well-recognized alarm symptom and such patients are likely to be referred for colonoscopy. Colonoscopy is unanimously recommended in patients aged > or = 50. Diverticulosis, vascular ectasias, and ischemic colitis are common causes of acute lower gastrointestinal bleeding (LGIB); CRC is found in 0.2 %-11 % of the colonoscopies performed for LGIB. Most patients with scant hematochezia have an anorectal or a distal source of bleeding. The expert panel considered most clinical indications for colonoscopy as appropriate in the presence of IDA (58 %) or hematochezia (83 %). CONCLUSION: Despite the limitations of the published studies, guidelines unanimously recommend colonoscopy for the investigation of IDA and hematochezia in patients aged > or = 50 years. These indications were also considered appropriate by EPAGE II, as were indications in patients at low risk for CRC with no obvious cause of bleeding found during adequate previous investigations.

Disseny d'un sistema de control del consum d'aigua automàtic

Avui en dia s’ha convertit en una necessitat tenir cura del medi ambient i optimitzar els recursos naturals. En el camp per estalviar energia s’han fet grans progressos i disposem d’un gran ventall de dispositius que ens ajuden i ens faciliten l’optimització del consum d’energia. Però és una realitat que en l’estalvi del consum d’aigua el progrés ha estat molt menor i es limita molt a donar consells i repartir dosificadors d’aigua. Qui no ha vist carrers o jardins o cases inundades amb milers de litres d’aigua? Aquesta realitat m’ha portat a dissenyar i desenvolupar un prototip que em permeti tenir un millor control del consum d’aigua. El prototip, a trets principals, consta d’un sensor, una electrovàlvula i una placa Arduino Atmega. El sensor ens permet mesurar els litres consumits durant un cert període de temps. Passat aquest temps de mostreig es compara els litres consumits amb el consum habitual, en aquell període de temps. En cas de sobrepassar el volum programat es tancarà l’electrovàlvula de forma automàtica i rebrem un SMS al telèfon. L’activació de l’alarma es pot ajustar que sigui al igualar-se els dos valors, litres programats i litres consumits. També es pot programar el percentatge que cal sobrepassar de litres consumits per activar l’alarma, com el temps de mostreig. El fet de poder programar tots aquests valors ens permet fer un ajust ideal per a la instal·lació que es vol tenir controlada. A més, el prototip es pot utilitzar per enviar a la companyia d’aigua el valor del comptador de forma automàtica. D’aquesta forma la companyia d’aigua també optimitza recursos estalviant-se el desplaçament de personal a la instal·lació per fer la lectura corresponent. El prototip està basat amb un Arduino Atmega que ens permet el processament de les dades programades i capturades pel sensor. També s’ha incorporat una pantalla TFT Touch 2’8”, que permet visualitzar i programar els valors d’una forma molt més intuïtiva. Per enviar els SMS s’utilitza una placa d’Arduino Cel·lular Shield - SM5100B, a la qual només cal afegir una targeta SIM. A priori, el prototip té un elevat cost al fabricar una sola unitat i pot semblar poc útil. Però ens pot estalviar alguna sorpresa en les factures d’aigua si tenim una fuita i no ens n’adonem fins a veure el rebut de la companyia. Si es fabriqués a grans quantitats es podria abaratir el preu i fer-lo encara més engrescador.

Sensory response of the egg parasitoid Telenomus podisi to stimuli from the bug Euschistus heros

The objective of this work was to study the foraging behavior of Telenomus podisi Ashmead (Hymenoptera: Scelionidae) in the presence of stimuli from its host, Euschistus heros (Heteroptera: Pentatomidae). The stimuli selected were: egg mass; virgin males and females; volatile extracts of sexually mature males and females; components of male sex pheromone; a component of the alarm pheromone, hexane and an empty cage as control. In a closed arena, the parasitoids were given the choice between single and combined stimuli presented to them simultaneously. To find the host egg, T. podisi primarily uses the sensory cues released from the male insects. The orientation toward odors of male chemical extract indicates that a source of kairomone was detected. Gas chromatographic analyses of this substance showed peak of methyl 2,6,10-trimethyltridecanoate, the main component of male sexual pheromone. The sensory response to methyl 2,6,10-trimethyltridecanoate confirms that this compound may act as a kairomone to find host eggs. Females and egg mass stimuli were weakly attractive to the parasitoid.

Sensing the environment : a role for the mouse olfactory subsystems

Summary : Four distinct olfactory subsystems compose the mouse olfactory system, the main olfactory epithelium (MOE), the septal organ of Masera (SO), the vomeronasal organ (VNO) and the Grueneberg ganglion (GG). They are implicated in the sensory modalities of the animal and they evolved to analyse and discriminate molecules carrying chemical messages, such as odorants and pheromones. In this thesis, the VNO, principally implicated in pheromonal communications as well as the GG, which had no function attributed until this work, were investigated from their morphology to their physiological functions, using an array of biochemical and physiological methods. First, the roles of a particular protein, the CNGA4 ion channel, were investigated in the VNO. In the MOE, CNGA4 is expressed as a modulatory channel subunit implicated in odour discrimination and adaptation. Interestingly, this calcium channel is the unique member of the cyclic nucleotide-gated (CNG) family to be expressed in the VNO and up to this work its functions remained unknown. Using a combination of transgenic and knockout mice, as well as histological and physiological approaches, we have characterized CNGA4 expression in the VNO. A strong expression in immature neurons was found as well as in the microvilli of mature neurons (putative site of chemodetection). Interestingly and confirming its dual localisation, the genetic invalidation of the CNGA4 channel has, as consequences, a strong impairment in vomeronasal maturation as well as deficit in pheromone sensing. Thus the CNGA4 channel appears to be a multifunctional protein in the mouse VNO playing essential role(s) in this organ. During the second part of the work, the morphology of the most recently described olfactory subsystem, the Grueneberg ganglion, was investigated in detail. Interestingly we found that glial cells and ciliated neurons compose this olfactory ganglion. This particular morphological aspect was similar to the olfactory AWC neurons from C. elegans which was used for further comparisons. Thus as for AWC neurons, we found that GG neurons are sensitive to temperature changes and are able to detect highly volatile molecules. Indeed, the presence of alarm pheromones (APs) secreted by stressed mice, elicit strong cellular responses, as well as a GG dependent behavioural changes. Investigations on the signaling elements present in GG neurons revealed that, as for AWC neurons, or pGC-D expressing neurons from the MOE, proteins participating in a cGMP pathway were found in GG neurons such as pGC-G and CNGA3 channels. These two proteins might be implicated in chemosensing as well as in thermosensing, two apparent properties of this organ. In this thesis, the multisensory modalities of two mouse olfactory subsystems were described and are related to a high degree of complexity required for the animal to sense its environment