A generic persistence model for CLP systems (and two useful implementations)

This paper describes a model of persistence in (C)LP languages and two different and practically very useful ways to implement this model in current systems. The fundamental idea is that persistence is a characteristic of certain dynamic predicates (Le., those which encapsulate state). The main effect of declaring a predicate persistent is that the dynamic changes made to such predicates persist from one execution to the next one. After proposing a syntax for declaring persistent predicates, a simple, file-based implementation of the concept is presented and some examples shown. An additional implementation is presented which stores persistent predicates in an external datábase. The abstraction of the concept of persistence from its implementation allows developing applications which can store their persistent predicates alternatively in files or databases with only a few simple changes to a declaration stating the location and modality used for persistent storage. The paper presents the model, the implementation approach in both the cases of using files and relational databases, a number of optimizations of the process (using information obtained from static global analysis and goal clustering), and performance results from an implementation of these ideas

Improved costs and outcomes with conscious sedation vs general anesthesia in TAVR patients: Time to wake up?

BackgroundTranscatheter aortic valve replacement (TAVR) has become a commonplace procedure for the treatment of aortic stenosis in higher risk surgical patients. With the high cost and steadily increasing number of patients receiving TAVR, emphasis has been placed on optimizing outcomes as well as resource utilization. Recently, studies have demonstrated the feasibility of conscious sedation in lieu of general anesthesia for TAVR. This study aimed to investigate the clinical as well as cost outcomes associated with conscious sedation in comparison to general anesthesia in TAVR.MethodsRecords for all adult patients undergoing TAVR at our institution between August 2012 and June 2016 were included using our institutional Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) registries. Cost data was gathered using the BIOME database. Patients were stratified into two groups according to whether they received general anesthesia (GA) or conscious sedation (CS) during the procedure. No-replacement propensity score matching was done using the validated STS predicted risk of mortality (PROM) as a propensity score. Primary outcome measure with survival to discharge and several secondary outcome measures were also included in analysis. According to our institution's data reporting guidelines, all cost data is presented as a percentage of the general anesthesia control group cost.ResultsOf the 231 patients initially identified, 225 (157 GA, 68 CS) were included for analysis. After no-replacement propensity score matching, 196 patients (147 GA, 49 CS) remained. Overall mortality was 1.5% in the matched population with a trend towards lower mortality in the CS group. Conscious sedation was associated with significantly fewer ICU hours (30 vs 96 hours, p = <0.001) and total hospital days (4.9 vs 10.4, p<0.001). Additionally, there was a 28% decrease in direct cost (p<0.001) as well as significant decreases in all individual all cost categories associated with the use of conscious sedation. There was no difference in composite major adverse events between groups. These trends remained on all subsequent subgroup analyses.ConclusionConscious sedation is emerging as a safe and viable option for anesthesia in patients undergoing transcatheter aortic valve replacement. The use of conscious sedation was not only associated with similar rates of adverse events, but also shortened ICU and overall hospital stays. Finally, there were significant decreases in all cost categories when compared to a propensity matched cohort receiving general anesthesia

Psychobiological Aspects of Panic Disorder

Anxiety is a useful warning sign that helps an individual face potential or real danger. At appropriate levels, it serves as a warning for the presence of internal or external threats, causing a person to be alert and prepare to deal appropriately with such situations. Moreover, moderate levels of anxiety can lead to improved performance in several activities. However, anxiety becomes pathological when its duration is excessively long or its intensity is extremely high and leads to significant suffering and distress. In such cases, anxiety is appropriately described as part of a pathological response, characterizing an anxiety disorder. The historical concept of a unitary anxiety disorder has been replaced by a heterogeneous group of psychopathologies with different etiologies. Panic disorder is a complex anxiety disorder that involves both recurrent, unexpected panic attacks, and persistent concern about having additional attacks. The present chapter reviews current psychobiological perspectives in the etiology and treatment of panic disorder. The first section describes the current classification of this anxiety disorder. We then explore possible neural circuitry associated with panic disorder. Finally, the chapter addresses current treatment approaches, considering the efficacy of different forms of psychotherapy and pharmacological treatments

Incorporation of Non-metal Impurities at the Anatase TiO2_2(001)-(1×\times4) Surface

We use first-principles calculations to investigate the adsorption and incorporation of non-metal impurities (N, C) at the anatase TiO$_2$(001)-(1$\times$4) reconstructed surface. We analyze in detail the influence of the surface structure and local strain on the impurity binding sites and incorporation pathways and identify important intermediates which facilitate impurity incorporation. We find various subsurface interstitial binding sites and corresponding surface $\rightarrow$ subsurface penetration pathways on the reconstructed surface. This surface also favors the presence of subsurface oxygen-vacancies, to which adsorbed species can migrate to form substitutional impurities. Most notably, we show that the non-exposed oxygen sites just below the surface have a key role in the incorporation of nitrogen and carbon in TiO$_2$(001).Comment: 5 figure

The relationship between obesity and quality of life in Brazilian adults

The incidence of obesity has reached epidemic proportions, affecting 30% of the adult population globally. During the last decade, the rising rates of obesity in developing countries has been particularly striking. One potential consequence of obesity is a decline in quality of life. Thus, the objective of the present study was to investigate the possible relationship between obesity, defined by body mass index (BMI), and quality of life, evaluated using the short version of the World Health Organization Quality of Life (WHOQOL) scale in a Brazilian population. The sample consisted of 30 men and 30 women, divided into three groups according to BMI: normal weight, obese, and morbidly obese. All of the subjects responded to the WHOQOL inventories. The results indicated that the groups with lower BMIs had better quality of life than the groups with higher BMIs. Being overweight interfered with quality of life equally in both sexes, with no difference found between men and women. The results indicate the necessity of multidisciplinary care of obese individuals

Utilidad de la reconstrucción tridimensional con tomografía computarizada en Traumatología y Ortopedia

La reconstrucción tridimensional es una nuev a técnica diagnóstica introducida en cirugía ortopédica y traumatología. Está indicada en algunas fracturas de acetábulo, columna y pelvis porque facilita una visión desde diferente s ángulos y en determinadas lesiones congénitas donde es imprescindible una correcta evaluación preoperatoria. Presentamo s dos paciente s con fracturas acetabulares, otro con lesión me - tastásica en columna lumbar y otro con hipoplasia del arco neural de cuarta vértebra lumbar. La reconstrucción tridimensional fue útil para el definitivo diagnóstico en los cuatro pacientes.Three dimensional images is a new technique introduced in orthopaedic surgery and traumatology. It's indicated for some fractures of the acetabulum, spine or pelvic girdle becaus e supply a vision from differents angles and in determinated congenital damage s who is indispensable an accurate evaluation before the surgery. We presented two patients with acetabular fractures, other with a metastasi c tumour in lumbar spine and anothe r with a hipoplasti c neural arch in a lumbar vertebra. The thre e dimensional reconstruction was useful for the definitive diagnostic in the four patients

A generic persistence model for CLP systems

This paper describes a model of persistence in (C)LP languages and two different and practically very useful ways to implement this model in current systems. The fundamental idea is that persistence is a characteristic of certain dynamic predicates (i.e., those which encapsulate state). The main effect of declaring a predicate persistent is that the dynamic changes made to such predicates persist from one execution to the next one. After proposing a syntax for declaring persistent predicates, a simple, file-based implementation of the concept is presented and some examples shown. An additional implementation is presented which stores persistent predicates in an external database. The abstraction of the concept of persistence from its implementation allows developing applications which can store their persistent predicates alternatively in files or databases with only a few simple changes to a declaration stating the location and modality used for persistent storage. The paper presents the model, the implementation approach in both the cases of using files and relational databases, a number of optimizations of the process (using information obtained from static global analysis and goal clustering), and performance results from an implementation of these ideas