JPEG linked media format (JLINK) applications

The growing and emerging of the large use of images in recent decades has fostered the need to innovate with new functionalities and applications. That is the reason why the Joint Photographic Experts Group (JPEG) is currently developing new standards. This thesis focuses on the JPEG Systems Part 7: JPEG Linked Media Format (JLINK) standard, which aims to allow a set of related images to be encapsulated in a single, and, through an adapted viewer, to move between images through interactive points. The main objective of the project is to implement an application that allows to create, visualize and modify this type of files defined by the specifications of the standard. The result has been a web application capable of performing the aforementioned actions, with the addition of more functions. It also has a database to have control of the stored files. The usefulness of defining a standard has been proven, and the importance of developers to check that the specifications given are correct or need to be modified.El creciente y emergente uso de imágenes en las últimas décadas ha fomentado la necesidad de innovar con nuevas funcionalidades y aplicaciones. Por ello, el Joint Photographic Experts Group (JPEG) está desarrollando actualmente nuevos estándares. Esta tesis se centra en el estándar JPEG Systems Part 7: JPEG Linked Media Format (JLINK), que pretende permitir encapsular un conjunto de imágenes relacionadas en una sola, y, a través de un visor adaptado, moverse entre las imágenes mediante puntos interactivos. El objetivo principal del proyecto es implementar una aplicación que permita crear, visualizar y modificar este tipo de archivos definidos por las especificaciones del estándar. El resultado ha sido una aplicación web capaz de realizar las acciones mencionadas, con el añadido de más funciones. También dispone de una base de datos para tener el control de los ficheros almacenados. Se ha comprobado la utilidad de la definición de un estándar y la importancia de que los desarrolladores comprueben que las especificaciones dadas son correctas o deben ser modificadas.El creixement i l'aparició de l'ampli ús de les imatges a les darreres dècades ha fomentat la necessitat d'innovar amb noves funcionalitats i aplicacions. Per això, el Joint Photographic Experts Group (JPEG) està desenvolupant actualment nous estàndards. Aquesta tesi se centra en l'estàndard JPEG Systems Part 7: JPEG Linked Media Format (JLINK), que pretén permetre encapsular un conjunt d'imatges relacionades en una de sola, i, mitjançant un visor adaptat, moure's entre les imatges mitjançant punts interactius. L'objectiu principal del projecte és implementar una aplicació que permeti crear, visualitzar i modificar aquest tipus de fitxers definits per les especificacions de l'estàndard. El resultat ha estat una aplicació web capaç de fer les accions esmentades, amb l'afegit de més funcions. També disposa d'una base de dades per tenir el control dels fitxers emmagatzemats. S'ha comprovat la utilitat de la definició d'un estàndard i la importància que els desenvolupadors comprovin que les especificacions donades són correctes o s'han de modificar

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Modelado hidrológico de grandes cuencas: caso de estudio del Río Senegal, África Occidental

El presente trabajo tiene como objetivo la modelación de los escurrimientos diarios de grandes cuencas bajo el empleo del modelo de parámetros distribuidos CEQUEAU y del software de sistemas de información geográfica IDRISI . Se implementó un módulo hidrogeomático que proporciona, bajo un proceso supervisado, la información de entrada requerida por el modelo hidrológico. Se han utilizado imágenes de radar SRTM ( Shuttle Radar Topography Mission-USGS ), con resolución espacial de 30 ( 1 km) para la delimitación del parteaguas de la cuenca, con lo cual se eliminan fuentes de incertidumbre significativas, reduciendo tiempos de procesamiento. El caudal del río Senegal ha sido aforado en la estación hidrométrica Bakel desde inicios del siglo XX y se cuenta con una serie de datos relativamente abundante. Se han llevado a cabo diversos estudios hidrológicos sobre la cuenca, donde se reporta un área de captación cercana a 289 x 10 3 km 2 , pero altamente subestimada, según revela este estudio. La cuenca presenta condiciones climáticas muy diversas, con alta variabilidad en la precipitación total anual, desde 2 000 mm en el sur hasta 50 mm en el norte. Los parámetros fisiográficos han sido calculados considerando la extensa superficie de la cuenca localizada en Mauritania, despreciada en estudios previos como parte de ésta. Las simulaciones de caudales para el periodo 1970-2000 generan buenos resultados (coeficiente de Nash, por lo general superiores a 0.80), por ello se concluye que utilizando el nuevo módulo hidrogeomáico y el modelo CEQUEAU , las simulaciones son más adecuadas y representan una base sólida para la gestión de recursos hídricos de la zona

Stress neuropeptide levels in adults with chest pain due to coronary artery disease: potential implications for clinical assessment

: Substance P (SP) and neuropeptide Y (NPY) are neuropeptides involved in nociception. The study of biochemical markers of pain in communicating critically ill coronary patients may provide insight for pain assessment and management in critical care. Purpose of the study was to to explore potential associations between plasma neuropeptide levels and reported pain intensity in coronary critical care adults, in order to test the reliability of SP measurements for objective pain assessment in critical care

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit