Umidificação e aquecimento do gás inalado em estação de anestesia com baixo fluxo de gases frescos com ou sem isolamento térmico do circuito ventilatório e com ou sem permutador de umidade e temperatura

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Umidificação e aquecimento do gás inalado em estação de anestesia com baixo fluxo de gases frescos com ou sem isolamento térmico do circuito ventilatório e com ou sem permutador de umidade e temperatura

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Predicting dysthyroid optic neuropathy using computed tomography volumetric analyses of orbital structures

OBJECTIVE: To evaluate the ability of orbital apex crowding volume measurements calculated with multidetector-computed tomography to detect dysthyroid optic neuropathy. METHODS: Ninety-three patients with Graves' orbitopathy were studied prospectively. All of the patients underwent a complete neuro-ophthalmic examination and computed tomography scanning. Volumetric measurements were calculated from axial and coronal contiguous sections using a dedicated workstation. Orbital fat and muscle volume were estimated on the basis of their attenuation values (in Hounsfield units) using measurements from the anterior orbital rim to the optic foramen. Two indexes of orbital muscle crowding were calculated: i) the volumetric crowding index, which is the ratio between soft tissue (mainly extraocular muscles) and orbital fat volume and is based on axial scans of the entire orbit; and ii) the volumetric orbital apex crowding index, which is the ratio between the extraocular muscles and orbital fat volume and is based on coronal scans of the orbital apex. Two groups of orbits (with and without dysthyroid optic neuropathy) were compared. RESULTS: One hundred and two orbits of 61 patients with Graves' orbitopathy met the inclusion criteria and were analyzed. Forty-one orbits were diagnosed with Graves' orbitopathy, and 61 orbits did not have optic neuropathy. The two groups of orbits differed significantly with regard to both of the volumetric indexes (p<0.001). Although both indexes had good discrimination ability, the volumetric orbital apex crowding index yielded the best results with 92% sensitivity, 86% specificity, 81%/94% positive/negative predictive value and 88% accuracy at a cutoff of 4.14. CONCLUSION: This study found that the orbital volumetric crowding index was a more effective predictor of dysthyroid optic neuropathy than previously described computed tomography indexes were.

Cone Beam Computed Tomographic Imaging: Perspective, Challenges, and the Impact of Near-Trend Future Applications

Cone beam computed tomography (CBCT) can be considered as a valuable imaging modality for improving diagnosis and treatment planning to achieve true guidance for several craniofacial surgical interventions. A new concept and perspective in medical informatics is the highlight discussion about the new imaging interactive workflow. The aim of this article was to present, in a short literature review, the usefulness of CBCT technology as an important alternative imaging modality, highlighting current practices and near-term future applications in cutting-edge thought-provoking perspectives for craniofacial surgical assessment. This article explains the state of the art of CBCT improvements, medical workstation, and perspectives of the dedicated unique hardware and software, which can be used from the CBCT source. In conclusion, CBCT technology is developing rapidly, and many advances are on the horizon. Further progress in medical workstations, engineering capabilities, and improvement in independent software-some open source-should be attempted with this new imaging method. The perspectives, challenges, and pitfalls in CBCT will be delineated and evaluated along with the technological developments.

Large-scale coupled-cluster calculations

Coupled-cluster theory provides one of the most successful concepts in electronic-structure theory. This work covers the parallelization of coupled-cluster energies, gradients, and second derivatives and its application to selected large-scale chemical problems, beside the more practical aspects such as the publication and support of the quantum-chemistry package ACES II MAB and the design and development of a computational environment optimized for coupled-cluster calculations. The main objective of this thesis was to extend the range of applicability of coupled-cluster models to larger molecular systems and their properties and therefore to bring large-scale coupled-cluster calculations into day-to-day routine of computational chemistry. A straightforward strategy for the parallelization of CCSD and CCSD(T) energies, gradients, and second derivatives has been outlined and implemented for closed-shell and open-shell references. Starting from the highly efficient serial implementation of the ACES II MAB computer code an adaptation for affordable workstation clusters has been obtained by parallelizing the most time-consuming steps of the algorithms. Benchmark calculations for systems with up to 1300 basis functions and the presented applications show that the resulting algorithm for energies, gradients and second derivatives at the CCSD and CCSD(T) level of theory exhibits good scaling with the number of processors and substantially extends the range of applicability. Within the framework of the ’High accuracy Extrapolated Ab initio Thermochemistry’ (HEAT) protocols effects of increased basis-set size and higher excitations in the coupled- cluster expansion were investigated. The HEAT scheme was generalized for molecules containing second-row atoms in the case of vinyl chloride. This allowed the different experimental reported values to be discriminated. In the case of the benzene molecule it was shown that even for molecules of this size chemical accuracy can be achieved. Near-quantitative agreement with experiment (about 2 ppm deviation) for the prediction of fluorine-19 nuclear magnetic shielding constants can be achieved by employing the CCSD(T) model together with large basis sets at accurate equilibrium geometries if vibrational averaging and temperature corrections via second-order vibrational perturbation theory are considered. Applying a very similar level of theory for the calculation of the carbon-13 NMR chemical shifts of benzene resulted in quantitative agreement with experimental gas-phase data. The NMR chemical shift study for the bridgehead 1-adamantyl cation at the CCSD(T) level resolved earlier discrepancies of lower-level theoretical treatment. The equilibrium structure of diacetylene has been determined based on the combination of experimental rotational constants of thirteen isotopic species and zero-point vibrational corrections calculated at various quantum-chemical levels. These empirical equilibrium structures agree to within 0.1 pm irrespective of the theoretical level employed. High-level quantum-chemical calculations on the hyperfine structure parameters of the cyanopolyynes were found to be in excellent agreement with experiment. Finally, the theoretically most accurate determination of the molecular equilibrium structure of ferrocene to date is presented.

Heterogeneous Multi-core Architectures for High Performance Computing

This thesis deals with heterogeneous architectures in standard workstations. Heterogeneous architectures represent an appealing alternative to traditional supercomputers because they are based on commodity components fabricated in large quantities. Hence their price-performance ratio is unparalleled in the world of high performance computing (HPC). In particular, different aspects related to the performance and consumption of heterogeneous architectures have been explored. The thesis initially focuses on an efficient implementation of a parallel application, where the execution time is dominated by an high number of floating point instructions. Then the thesis touches the central problem of efficient management of power peaks in heterogeneous computing systems. Finally it discusses a memory-bounded problem, where the execution time is dominated by the memory latency. Specifically, the following main contributions have been carried out: A novel framework for the design and analysis of solar field for Central Receiver Systems (CRS) has been developed. The implementation based on desktop workstation equipped with multiple Graphics Processing Units (GPUs) is motivated by the need to have an accurate and fast simulation environment for studying mirror imperfection and non-planar geometries. Secondly, a power-aware scheduling algorithm on heterogeneous CPU-GPU architectures, based on an efficient distribution of the computing workload to the resources, has been realized. The scheduler manages the resources of several computing nodes with a view to reducing the peak power. The two main contributions of this work follow: the approach reduces the supply cost due to high peak power whilst having negligible impact on the parallelism of computational nodes. from another point of view the developed model allows designer to increase the number of cores without increasing the capacity of the power supply unit. Finally, an implementation for efficient graph exploration on reconfigurable architectures is presented. The purpose is to accelerate graph exploration, reducing the number of random memory accesses.

Multicentre study for a robust protocol in single-voxel spectroscopy: quantification of MRS signals by time-domain fitting algorithms

Magnetic Resonance Spectroscopy (MRS) is an advanced clinical and research application which guarantees a specific biochemical and metabolic characterization of tissues by the detection and quantification of key metabolites for diagnosis and disease staging. The "Associazione Italiana di Fisica Medica (AIFM)" has promoted the activity of the "Interconfronto di spettroscopia in RM" working group. The purpose of the study is to compare and analyze results obtained by perfoming MRS on scanners of different manufacturing in order to compile a robust protocol for spectroscopic examinations in clinical routines. This thesis takes part into this project by using the GE Signa HDxt 1.5 T at the Pavillion no. 11 of the S.Orsola-Malpighi hospital in Bologna. The spectral analyses have been performed with the jMRUI package, which includes a wide range of preprocessing and quantification algorithms for signal analysis in the time domain. After the quality assurance on the scanner with standard and innovative methods, both spectra with and without suppression of the water peak have been acquired on the GE test phantom. The comparison of the ratios of the metabolite amplitudes over Creatine computed by the workstation software, which works on the frequencies, and jMRUI shows good agreement, suggesting that quantifications in both domains may lead to consistent results. The characterization of an in-house phantom provided by the working group has achieved its goal of assessing the solution content and the metabolite concentrations with good accuracy. The goodness of the experimental procedure and data analysis has been demonstrated by the correct estimation of the T2 of water, the observed biexponential relaxation curve of Creatine and the correct TE value at which the modulation by J coupling causes the Lactate doublet to be inverted in the spectrum. The work of this thesis has demonstrated that it is possible to perform measurements and establish protocols for data analysis, based on the physical principles of NMR, which are able to provide robust values for the spectral parameters of clinical use.

Medicina interventistica: Sviluppo di un concentratore di dati clinico-strumentali con applicazioni in telemedicina

Un limite rilevante delle apparecchiature elettromedicali presenti in una comune sala operatoria/interventistica è rappresentato dal fatto che le informazioni clinico-strumentali che esse sono in grado di fornire vengono gestite localmente in maniera indipendente: ogni fabbricante di apparecchiatura medica, infatti, sviluppa standard proprietari per l’acquisizione, la presentazione e l’archiviazione dei dati. Ci si chiede se sia possibile una gestione globale, sincronizzata e personalizzata, delle informazioni clinico-strumentali acquisibili da diverse strumentazioni presenti nel medesimo contesto operatorio. La soluzione di SparkBio S.r.l. per colmare il gap esistente in materia di gestione di informazioni clinico-strumentali di sala è quella di concentrare le uscite video e le uscite analogiche dei vari dispositivi e visualizzarle contemporaneamente su di un unico monitor master. Il monitor master sarà suddiviso tramite una griglia in diversi settori ed ogni area predisposta per visualizzare il segnale video o analogico di un dispositivo presente in sala. Avendo a disposizione un’apparecchiatura con questa potenzialità, le applicazioni risultano innumerevoli: l’archiviazione di un unico file contenente la registrazione sincronizzata dei segnali delle varie sorgenti permette di documentare l’intera esecuzione della procedura al fine di una sua successiva visione e distribuzione: il confronto congiunto, fatto a posteriori, di parametri acquisiti da strumenti diversi rende possibile valutare particolari eventi; la condivisione con la comunità scientifica rende possibile la diffusione del sapere in materia di chirurgia. Inoltre la disponibilità di una collezione di dati concentrati in un’unica workstation apre la strada ad applicazioni nel campo della telemedicina: la condivisione a distanza delle varie sorgenti raccolte e sincronizzate via WEB, tramite l’integrazione di un software per videoconferenza, permette di realizzare supporto remoto, e-learning, telementoring e teleproctoring. L’obiettivo di questa tesi è analizzare il processo di sviluppo di questo nuovo dispositivo medico denominato “OneView”, per poi passare alla progettazione di scenari specifici applicabili a diverse procedure chirurgiche.

Hydraulic evaluation of the gyro electric wave energy converter

Motivation Thanks for a scholarship offered by ALma Mater Studiorum I could stay in Denmark for six months during which I could do physical tests on the device Gyro PTO at the Departmet of Civil Engineering of Aalborg University. Aim The goal of my thesis is an hydraulic evaluation of the device: Gyro PTO, a gyroscopic device for conversion of mechanical energy in ocean surface waves to electrical energy. The principle of the system is the application of the gyroscopic moment of flywheels equipped on a swing float excited by waves. The laboratory activities were carried out by: Morten Kramer, Jan Olsen, Irene Guaraldi, Morten Thøtt, Nikolaj Holk. The main purpose of the tests was to investigate the power absorption performance in irregular waves, but testing also included performance measures in regular waves and simple tests to get knowledge about characteristics of the device, which could facilitate the possibility of performing numerical simulations and optimizations. Methodology To generate the waves and measure the performance of the device a workstation was created in the laboratory. The workstation consist of four computers in each of wich there was a different program. Programs have been used : Awasys6, LabView, Wave lab, Motive optitrack, Matlab, Autocad Main Results Thanks to the obtained data with the tank testing was possible to make the process of wave analisys. We obtained significant wave height and period through a script Matlab and then the values of power produced, and energy efficiency of the device for two types of waves: regular and irregular. We also got results as: physical size, weight, inertia moments, hydrostatics, eigen periods, mooring stiffness, friction, hydrodynamic coefficients etc. We obtained significant parameters related to the prototype in the laboratory after which we scale up the results obtained for two future applications: one in Nissun Brending and in the North Sea. Conclusions The main conclusion on the testing is that more focus should be put into ensuring a stable and positive power output in a variety of wave conditions. In the irregular waves the power production was negative and therefore it does not make sense to scale up the results directly. The average measured capture width in the regular waves was 0.21 m. As the device width is 0.63 m this corresponds to a capture width ratio of: 0.21/0.63 * 100 = 33 %. Let’s assume that it is possible to get the device to produce as well in irregular waves under any wave conditions, and lets further assume that the yearly absorbed energy can be converted into electricity at a PTO-efficiency of 90 %. Under all those assumptions the results in table are found, i.e. a Nissum Bredning would produce 0.87 MWh/year and a North Sea device 85 MWh/year.

Integrazione tra Sistemi di Autenticazione Dipartimentale e d'Ateneo

Il documento illustra il lavoro di analisi dei requisiti, progettazione, implementazione e valutazione di un sistema per l’autenticazione degli utenti delle workstation della sede di Scienze del Dipartimento di Informatica — Scienza ed Ingegneria (DISI) che si integri al sistema di autenticazione d’Ateneo. Il sistema descritto è entrato in produzione il 24 settembre 2014 ed è tuttora operante. Il lavoro percorre le modalità di gestione degli account utente in uso presso il DISI e le nuove modalità di organizzazione del DSA d’Ateneo discutendo le motivazioni per cui le soluzioni standard non possono essere adottate nel caso esposto. Analizzato il processo di login dei sistemi Unix e le librerie coinvolte verrà esposto il nuovo progetto, le particolarità dello sviluppo delle nuove librerie PAM e di Name Service Switch e la loro modalità di funzionamento e configurazione all’interno del cluster Unix. In conclusione vengono presentate una serie di valutazioni che mostrano i vantaggi e il rispetto dei requisiti della nuova implementazione.

Simulation in training: one-year experience using an efficiency index to assess interventional radiology fellow training status

PURPOSE: To compare objective fellow and expert efficiency indices for an interventional radiology renal artery stenosis skill set with the use of a high-fidelity simulator. MATERIALS AND METHODS: The Mentice VIST simulator was used for three different renal artery stenosis simulations of varying difficulty, which were used to grade performance. Fellows' indices at three intervals throughout 1 year were compared to expert baseline performance. Seventy-four simulated procedures were performed, 63 of which were captured as audiovisual recordings. Three levels of fellow experience were analyzed: 1, 6, and 12 months of dedicated interventional radiology fellowship. The recordings were compiled on a computer workstation and analyzed. Distinct measurable events in the procedures were identified with task analysis, and data regarding efficiency were extracted. Total scores were calculated as the product of procedure time, fluoroscopy time, tools, and contrast agent volume. The lowest scores, which reflected efficient use of tools, radiation, and time, were considered to indicate proficiency. Subjective analysis of participants' procedural errors was not included in this analysis. RESULTS: Fellows' mean scores diminished from 1 month to 12 months (42,960 at 1 month, 18,726 at 6 months, and 9,636 at 12 months). The experts' mean score was 4,660. In addition, the range of variance in score diminished with increasing experience (from a range of 5,940-120,156 at 1 month to 2,436-85,272 at 6 months and 2,160-32,400 at 12 months). Expert scores ranged from 1,450 to 10,800. CONCLUSIONS: Objective efficiency indices for simulated procedures can demonstrate scores directly comparable to the level of clinical experience.

Automated design of self-stabilization

Self-stabilization is a property of a distributed system such that, regardless of the legitimacy of its current state, the system behavior shall eventually reach a legitimate state and shall remain legitimate thereafter. The elegance of self-stabilization stems from the fact that it distinguishes distributed systems by a strong fault tolerance property against arbitrary state perturbations. The difficulty of designing and reasoning about self-stabilization has been witnessed by many researchers; most of the existing techniques for the verification and design of self-stabilization are either brute-force, or adopt manual approaches non-amenable to automation. In this dissertation, we first investigate the possibility of automatically designing self-stabilization through global state space exploration. In particular, we develop a set of heuristics for automating the addition of recovery actions to distributed protocols on various network topologies. Our heuristics equally exploit the computational power of a single workstation and the available parallelism on computer clusters. We obtain existing and new stabilizing solutions for classical protocols like maximal matching, ring coloring, mutual exclusion, leader election and agreement. Second, we consider a foundation for local reasoning about self-stabilization; i.e., study the global behavior of the distributed system by exploring the state space of just one of its components. It turns out that local reasoning about deadlocks and livelocks is possible for an interesting class of protocols whose proof of stabilization is otherwise complex. In particular, we provide necessary and sufficient conditions – verifiable in the local state space of every process – for global deadlock- and livelock-freedom of protocols on ring topologies. Local reasoning potentially circumvents two fundamental problems that complicate the automated design and verification of distributed protocols: (1) state explosion and (2) partial state information. Moreover, local proofs of convergence are independent of the number of processes in the network, thereby enabling our assertions about deadlocks and livelocks to apply on rings of arbitrary sizes without worrying about state explosion.

Depiction of small veins draining into the vein of galen using preoperative 3-dimensional navigation in living patients

OBJECTIVE: The purpose of this study was to delineate the anatomy of the precentral cerebellar vein, superior vermian vein, and internal occipital vein using reconstructions of computed tomographic and magnetic resonance imaging scans with navigation software. These data were compared with previous anatomic and angiographic findings to show the resolution and accuracy of the system. METHODS: We retrospectively reviewed 100 patients with intracranial pathologies (50 computed tomographic scans with contrast and 50 magnetic resonance imaging scans with gadolinium) using a neuronavigation workstation for 3-dimensional reconstruction. Particular attention was paid to depiction of the precentral cerebellar vein, superior vermian vein, and internal occipital vein. The data were reviewed and analyzed. RESULTS: The precentral cerebellar vein, superior vermian vein, and its tributary, the supraculminate vein, were depicted in 52 (52%) patients. The internal occipital vein was delineated on 99 (49.5%) sides and joined the basal vein and vein of Galen in 39 (39.4%) and 60 (60.6%) hemispheres, respectively. Comparing these results with previous angiographic studies, the ability of the neuronavigation system for depicting these vessels is similar to that of digital subtraction angiography. CONCLUSION: This study illustrates the possibility of depicting the small vessels draining into the pineal region venous complex using 3-dimensional neuronavigation with an accuracy comparable to that of digital subtraction angiography. This tool provides important information for both surgical planning and intraoperative orientation.

Body Height Estimation from Femur Measurements in Postmortem Computed Tomography

After attending this presentation, attendees will: (1) understand how body height from computed tomography data can be estimated; and, (2) gain knowledge about the accuracy of estimated body height and limitations. The presentation will impact the forensic science community by providing knowledge and competence which will enable attendees to develop formulas for single bones to reconstruct body height using postmortem Computer Tomography (p-CT) data. The estimation of Body Height (BH) is an important component of the identification of corpses and skeletal remains. Stature can be estimated with relative accuracy via the measurement of long bones, such as the femora. Compared to time-consuming maceration procedures, p-CT allows fast and simple measurements of bones. This study undertook four objectives concerning the accuracy of BH estimation via p-CT: (1) accuracy between measurements on native bone and p-CT imaged bone (F1 according to Martin 1914); (2) intra-observer p-CT measurement precision; (3) accuracy between formula-based estimation of the BH and conventional body length measurement during autopsy; and, (4) accuracy of different estimation formulas available.1 In the first step, the accuracy of measurements in the CT compared to those obtained using an osteometric board was evaluated on the basis of eight defleshed femora. Then the femora of 83 female and 144 male corpses of a Swiss population for which p-CTs had been performed, were measured at the Institute of Forensic Medicine in Bern. After two months, 20 individuals were measured again in order to assess the intraobserver error. The mean age of the men was 53±17 years and that of the women was 61±20 years. Additionally, the body length of the corpses was measured conventionally. The mean body length was 176.6±7.2cm for men and 163.6±7.8cm for women. The images that were obtained using a six-slice CT were reconstructed with a slice thickness of 1.25mm. Analysis and measurements of CT images were performed on a multipurpose workstation. As a forensic standard procedure, stature was estimated by means of the regression equations by Penning & Riepert developed on a Southern German population and for comparison, also those referenced by Trotter & Gleser “American White.”2,3 All statistical tests were performed with a statistical software. No significant differences were found between the CT and osteometric board measurements. The double p-CT measurement of 20 individuals resulted in an absolute intra-observer difference of 0.4±0.3mm. For both sexes, the correlation between the body length and the estimated BH using the F1 measurements was highly significant. The correlation coefficient was slightly higher for women. The differences in accuracy of the different formulas were small. While the errors of BH estimation were generally ±4.5–5.0cm, the consideration of age led to an increase in accuracy of a few millimetres to about 1cm. BH estimations according to Penning & Riepert and Trotter & Gleser were slightly more accurate when age-at-death was taken into account.2,3 That way, stature estimations in the group of individuals older than 60 years were improved by about 2.4cm and 3.1cm.2,3 The error of estimation is therefore about a third of the common ±4.7cm error range. Femur measurements in p-CT allow very accurate BH estimations. Estimations according to Penning led to good results that (barely) come closer to the true value than the frequently used formulas by Trotter & Gleser “American White.”2,3 Therefore, the formulas by Penning & Riepert are also validated for this substantial recent Swiss population.

Aortic morphometry at endograft position as assessed by 3D image analysis affects risk of type I endoleak formation after TEVAR

PURPOSE The purpose of this study was to identify morphologic factors affecting type I endoleak formation and bird-beak configuration after thoracic endovascular aortic repair (TEVAR). METHODS Computed tomography (CT) data of 57 patients (40 males; median age, 66 years) undergoing TEVAR for thoracic aortic aneurysm (34 TAA, 19 TAAA) or penetrating aortic ulcer (n = 4) between 2001 and 2010 were retrospectively reviewed. In 28 patients, the Gore TAG® stent-graft was used, followed by the Medtronic Valiant® in 16 cases, the Medtronic Talent® in 8, and the Cook Zenith® in 5 cases. Proximal landing zone (PLZ) was in zone 1 in 13, zone 2 in 13, zone 3 in 23, and zone 4 in 8 patients. In 14 patients (25%), the procedure was urgent or emergent. In each case, pre- and postoperative CT angiography was analyzed using a dedicated image processing workstation and complimentary in-house developed software based on a 3D cylindrical intensity model to calculate aortic arch angulation and conicity of the landing zones (LZ). RESULTS Primary type Ia endoleak rate was 12% (7/57) and subsequent re-intervention rate was 86% (6/7). Left subclavian artery (LSA) coverage (p = 0.036) and conicity of the PLZ (5.9 vs. 2.6 mm; p = 0.016) were significantly associated with an increased type Ia endoleak rate. Bird-beak configuration was observed in 16 patients (28%) and was associated with a smaller radius of the aortic arch curvature (42 vs. 65 mm; p = 0.049). Type Ia endoleak was not associated with a bird-beak configuration (p = 0.388). Primary type Ib endoleak rate was 7% (4/57) and subsequent re-intervention rate was 100%. Conicity of the distal LZ was associated with an increased type Ib endoleak rate (8.3 vs. 2.6 mm; p = 0.038). CONCLUSIONS CT-based 3D aortic morphometry helps to identify risk factors of type I endoleak formation and bird-beak configuration during TEVAR. These factors were LSA coverage and conicity within the landing zones for type I endoleak formation and steep aortic angulation for bird-beak configuration.