Computer-based lung sound simulation

An algorithm for the simulation of normal and pathological lung sounds is developed. The simulation algorithm is implemented on a personal computer as well as on a digital signal processor system in real time. Normal, bronchial and tracheal breathing sounds can be generated, and continuous and discontinuous adventitious lung sounds can be added. The attributes of the individual sound components, such as loudness, frequency, duration or number of occurrences within one breathing cycle, are controlled by the user. The quality of the simulations is evaluated by sending audio tapes to 15 experienced pulmonary physicians for a formal assessment. Each tape contains five simulated lung sounds and five real lung sounds from a commercially available teaching tape, presented in random order. Simulated lung sounds are slightly better rated in terms of realism and signal quality when compared to the recordings from the teaching tape. The differences are, however, not significant. 13 out of the 15 physicians feel that computer-based lung sound simulators would be a useful and desirable teaching tool for auscultation course

Agricultura Familiar en Uruguay perspectivas desde la formación integral

A partir del año 2007 el Grupo Disciplinario de Sociología Rural de la Facultad de Agronomía impulsó la realización de un curso de grado para abordar la temática de la agricultura familiar en Uruguay. Desde el inicio fue claro que la comprensión del tema exigía trascender el espacio del aula para conocer las distintas realidades de la producción familiar en Uruguay y poder analizarlas en profundidad. Es así que el curso se realiza en torno a los diversos actores presentes en distintos territorios de nuestro país. La consigna es que los estudiantes puedan llevar adelante actividades de investigación y extensión, incorporando elementos conceptuales en torno a la producción familiar. Se incorporan además distintas perspectivas para el análisis, en un principio la perspectiva de la pluriactividad como forma de resistencia de la producción familiar, más adelante se priorizó el análisis desde el territorio y hacia el futuro el análisis se centrará en la sucesión o relevo generacional. En este marco, el equipo docente, intenta actuar como disparador para la discusión de los temas abordados, además de brindar elementos históricos y actuales sobre el territorio y los distintos actores. El curso tiene además la particularidad y fortaleza de incorporar la interdisciplina, tanto a nivel del equipo docente como en el grupo de estudiantes que participan año a año. Esto no es casual y surge a partir de la práctica, una vez que se comenzó a tratar la temática, fundamentalmente desde la Agronomía y la Sociología, se entendió que era preciso complejizar la mirada e incorporar nuevas disciplinas, es así que se amplía el equipo docente y también la convocatoria estudiantil. En la actualidad, el equipo  está formado por docentes de distintas disciplinas y regiones del país, y los estudiantes provienen de, por lo menos cinco servicios universitarios. A partir de lo elementos planteados, el presente trabajo pretende analizar cómo la incorporación de la extensión a las actividades de enseñanza-aprendizaje, permite generar un diferencial en la formación y la apropiación de los distintos temas por parte de los estudiantes, a la vez que permite visualizar líneas de desarrollo y abordaje de las distintas problemáticas vinculadas a la agricultura familiar, enriquece la formación docente y genera cohesión a la interna del equipo docente

Low specificity of the bacterial index for the diagnosis of bacterial pneumonia by bronchoalveolar lavage

The bacterial index (BI) as defined by the sum of log10 colony-forming units (cfu) of microorganisms per milliliter of bronchoalveolar lavage (BAL) fluid, i.e., a multiplication of the single cfu/ml, has been used to distinguish between polymicrobial pneumonia (BI≥5) and colonization (BI<5). Since many false-positive results are to be expected using this parameter, the diagnostic value of the BI was studied prospectively by obtaining bacteriologic cultures of BAL fluid in 165 consecutive unselected patients. In 27 cases the diagnosis of bacterial pneumonia was established on clinical criteria. In 133 patients pneumonia could be excluded, and in five patients the diagnosis remained unclear. Using a cut-off of ≥105 cfu/ml BAL fluid, sensitivity and specificity for the diagnosis of pneumonia were 33% (9/27) and 99% (132/133), respectively. Sensitivity was mainly influenced by prior treatment with antibiotics, being 70% (7/10) in untreated and 12% (2/17) in treated patients. Applying the BI methodology at a cut-off of ≥ 5, however, resulted in an unacceptably high rate of 16 additional false-positive results, thus lowering the specificity to 87% (116/133;P<0.0001) while increasing the sensitivity to only 41% (11/27;P=0.77). In conclusion, given the high rate of false-positive results, the methodology of the BI is of doubtful value for the diagnosis of bacterial pneumonia by BAL in an unselected patient group. By applying the absolute number of cfu/ml BAL fluid, however, positive bacteriologic cultures of BAL fluid are highly specific for the diagnosis of pneumonia. Their sensitivity is limited by previous antibiotic therap

"Medikamente sind Bomben" - zum Metapherngebrauch von Lungentransplantations-Patienten mit guter oder ungenügender Compliance

Fragestellung: Nach einer Organtransplantation finden komplexe psychologische Verarbeitungsprozesse statt. In der vorliegenden Studie wurde untersucht, welche Metaphern im Zusammenhang mit Transplantationserfahrungen verwendet werden, und ob Unterschiede zwischen Patienten mit guter bzw. ungenügender Compliance im Gebrauch dieser Metaphern bestehen. Methode: 14 lungentransplantierte Patienten wurden in einem halbstrukturierten Interview zu ihren Transplantationserfahrungen befragt. Ihre Compliance wurde von den behandelnden Ärzten eingeschätzt. Die Auswertung der Interviews erfolgte anhand einer Metaphernanalyse, welche Hinweise auf vor- und unbewusste Vorstellungen der Patienten liefert. Die Interraterreliabilität über die Metapherngruppen war Cohen’s Kappa K = 0.8. Ergebnisse: Die Patienten konzeptualisierten ihren Körper, aber auch ihr Selbst als ein “Gefäß”, dass sowohl materielle (z.B. die Lunge) wie immaterielle Objekte (z.B. Gedanken an den Spender, Affekte) enthält. Der wichtigste Unterschied zwischen den Compliance-Gruppen bestand darin, dass Patienten mit ungenügender Compliance eine grössere Distanz zur transplantierten Lunge erlebten. Auch konzeptualisierten sie ihren Körper bzw. ihr Selbst nicht als ein Gefäß, das die Lunge enthält. Diskussion: Die Ergebnisse zeigen, dass gute Compliance mit einer erfolgreichen Organintegration assoziiert ist, welche die Zugehörigkeit der Lunge in einem als Gefäß konzeptualisierten Körper bzw. Selbst umfasst. Patienten mit ungenügender Compliance nehmen die Lunge eher als Fremdkörper wahr. Diese Verarbeitungsprozesse sind teils bewusster, teils vor- und unbewusster Natur

The postpneumonectomy syndrome: clinical presentation and treatment

Background: Postpneumonectomy syndrome (PPS) is a rare complication after pneumonectomy. It consists of an excessive mediastinal shift resulting in compression and stretching of the tracheobronchial tree and the esophagus. The aim of this study was to give a comprehensive overview of diagnosis, variety of symptoms and evaluation of surgical treatment of PPS. Methods: We retrospectively reviewed the charts of all our patients with PPS since 1994 with respect to symptomatology, treatment and outcome. Our results were compared with case reports and case series in the literature. Results: Six women with a median age of 56.5 years (range 49-65) developed PPS after pneumonectomy for the treatment of lung cancer. Four presented with a right PPS and two with a left PPS, respectively. Symptoms consisted of shortness of breath in all patients and dysphagia as well as heartburn in two patients. Correction of PPS required re-exploration of the pneumonectomy space, reposition of the mediastinum followed by the insertion of single silicone prosthesis in five patients or fixation of the mediastinum with a xenopericardial graft in one patient. We could observe an improvement of the FEV(1)/FVC ratio in all our patients and the clinical improvement of shortness of breath was better than we expected by changes of lung function. Four patients returned to their regular activities with a follow-up of four years. We found 73 cases of PPS in the literature, on the right side in 50 patients (68%) and on the left side in 23 patients (32%). Fifty-nine patients (81%) were treated surgically. Symptoms can be suspicious for cardiogenic origin and vary from heartburn to recurrent syncopes. Conclusion: PPS is rare and not predictable. It can occur after right or left pneumonectomy. Symptoms are manifold and result from a shift, leading to compression and stretching of the two conduits located within the mediastinum, the tracheobronchial tree and the esophagus and consists of shortness of breath, stridor and heartburn. Diagnosis must be made by exclusion. Implantation of prosthesis is the most commonly used and effective treatmen

Management of radiation dermatitis in patients receiving cetuximab and radiotherapy for locally advanced squamous cell carcinoma of the head and neck: proposals for a revised grading system and consensus management guidelines

Background: Radiation dermatitis developing in patients receiving cetuximab concomitantly with radiotherapy for locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) is now recognized to have different pathophysiological and clinical characteristics to the radiation dermatitis associated with radiotherapy or concomitant chemotherapy and radiotherapy. Current grading tools were not designed to grade this type of radiation dermatitis; their use may lead to misclassification of reactions and inappropriate management strategies, potentially compromising cancer treatment. Patients and methods: An advisory board of seven leading European specialists (three medical oncologists, three radiation oncologists and a dermatologist) with extensive experience of the use of cetuximab plus radiotherapy produced consensus guidelines for the grading and management of radiation dermatitis in patients receiving cetuximab plus radiotherapy. Results: Modifications to the current, commonly used National Cancer Institute—Common Terminology Criteria for Adverse Events version 4.3 for grading radiation dermatitis were proposed. Updated management guidelines, building on previously published guidelines from 2008, were also proposed. Conclusions: The proposed revisions to the grading system and updated management guidelines described here represent important developments toward the more appropriate grading and effective management of radiation dermatitis in patients receiving cetuximab plus radiotherapy for LA SCCH

Aproveitamento de resíduos da construção civil na produção de concretos para uso em pavimentação de ciclovias

Trabalho de conclusão de curso (graduação)—Universidade de Brasília, Faculdade de Tecnologia, Departamento de Engenharia Civil e Ambiental, 2016.A indústria da construção civil representa, no Brasil, uma das maiores fontes de geração de lixo urbano, sendo responsável pelos chamados Resíduos da Construção Civil (RCC), que foram aumentando paralelamente com o crescimento das cidades e gerando problemas ambientais relacionados ao acúmulo e depósito incorreto desses materiais. Tendo esse fato em vista, o presente projeto buscou achar uma solução para melhorar a locação final dos RCC e devolvê-lo aos sistemas construtivos. Para tanto, fez-se necessário um estudo das legislações e normas brasileiras onde se concluiu que já existem leis que dão incentivo à reciclagem e especificam como esses resíduos devem ser alocados, além de normas de requisitos de reutilização dos RCC, mas que a efetividade de aplicação de ambas tem sido pouca. É proposto no trabalho a utilização dos RCC como agregado miúdo para produção de concretos para uso em pavimentos rígidos de ciclovias no Distrito Federal (DF), sendo essa uma boa opção principalmente pela necessidade crescente de incentivo do uso de meios de transporte que ajudem no descongestionamento e na redução da poluição nas cidades. Para determinar se a substituição do agregado miúdo convencional era possível foram realizados ensaios de caracterização do agregado miúdo reciclado obtido junto à empresa Fornecedora de Areia Bela Vista, de forma a comparar suas características com as exigidas pela norma de uso de agregados reciclados de RCC em pavimentação e concreto não estrutural, a NBR ABNT 15116:2004, e com os parâmetros de agregados convencionais. Além disso, foi produzido um concreto com uso desse material reciclado para verificar o seu comportamento em relação a um concreto convencional e também testar se tal concreto teria a capacidade de atender ao requisito de resistência à compressão uniaxial de 18 MPa de projeto do concreto utilizado na construção da ciclovia do Jardim Burle Marx, em Brasília. Os resultados dos experimentos de caracterização puderam comprovar a adequabilidade do material reciclado da referida fonte em relação à composição granulométrica, à absorção e o tamanho dos agregados ideais, além de mostrar que estes tinham massa específica e massa unitária menores que a de agregados miúdos convencionais. Já os estudos com o concreto, mostraram que o uso de tais agregados miúdos reciclados neste não impossibilitou que a resistência mecânica necessária fosse atingida. Comprovou-se, no entanto, que o concreto com o material reciclado estudado tende a ter pior trabalhabilidade e maior relação água/cimento, sendo recomendável o uso de aditivos para a melhoria de tais características. Apesar disso, foi possível concluir com os dados obtidos que o concreto com agregado miúdo reciclado testado tem condições de ser usado em pavimentos rígidos de ciclovias

In vitro antibacterial activity of ciprofloxacin on Escherichia coli: effect of bovine serum and inoculum size

The in vitro assays used to evaluate the activity of antibacterial drugs do not consider the patient\nimmune response, which is necessary for the successful recovery from infectious disease. In\nthis study the effect of the bovine serum and the bacterial concentration on the activity of\nciprofloxacin on a strain of Escherichia coli (ATCC 25922) was evaluated in vitro. The minimum\ninhibitory concentrations on Mueller Hinton broth and in presence of bovine serum were\n0.0188 and 0.0047 µg/ml respectively, while the value of the mutant prevention concentration\nestimated on Mueller Hinton agar was 0.60µg/ml. In the time-killing curve constructed on\nMueller Hinton broth, no concentration achieved an efficacy of 99.9% at the end of the assay,\nwhereas in presence of bovine serum the bactericidal activity increased directly with the increasing\nconcentrations, attaining efficacy values of 99,9% (bactericidal effect) y del 99,99% (bacterial\neradication). No concentrations reduced the viable bacteria at levels of bactericidal effect when\nthe time-kill curves where constructed in Muller-Hinton broth. The results obtained in this study\nshowed that the optima efficacy of ciprofloxacin on Escherichia coli depends on the inoculum\nsize ant the factors of the immune response present in bovine serum.Fil: Baroni, E. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias. Cátedra de Farmacología; ArgentinaFil: Russi, N. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias. Hospital de Salud Animal. Laboratorio de Microbiología; ArgentinaFil: Rubio, M. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias. Cátedra de Semiología; ArgentinaFil: Picco, E. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias. Cátedra de Farmacología; ArgentinaFil: Formentini, E. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias. Cátedra de Farmacología; ArgentinaLos ensayos in vitro utilizados para evaluar la actividad de los antimicrobianos no tienen en\ncuenta la respuesta inmune del paciente, la cual es necesaria para le resolución exitosa de la\nenfermedad infecciosa. En este estudio evaluó in vitro el efecto del suero bovino y la concentración\nbacteriana en la actividad de ciprofloxacina sobre una cepa de Escherichia coli (ATCC 25922). Las\nconcentraciones inhibitorias mínimas en caldo Mueller Hinton y en presencia de suero bovino\nfueron de 0,0188 y 0,0047 µg/ml respectivamente, mientras que el valor de la concentración\npreventiva de mutantes estimada en agar Mueller Hinton fue de 0,60 µg/ml. En los ensayos\nde curvas de muerte bacteriana construidos en caldo Mueller Hinton, ninguna concentración\nlogró una eficacia del 99,9% (efecto bactericida) al final del ensayo, mientras que en presencia\nde suero bovino la actividad bactericida se incrementó en forma directa con el incremento de\nlas concentraciones, logrando eficacias del 99,9% (efecto bactericida) y del 99,99% (efecto de\nerradicación bacteriana). En el ensayo de curva muerte construida en caldo Mueller Hinton en\npresencia de una elevada densidad bacteriana, ninguna concentración logró una reducción en el\nnúmero de bacterias viables compatible con un efecto bactericida. Los resultados obtenidos en\neste estudio muestran que la eficacia óptima de ciprofloxacina sobre la cepa de Escherichia coli\nfue condicionada por la carga bacteriana y los factores de respuesta inmune presentes en el suer