Convulsão Febril em crianças: uma revisão abrangente de diagnóstico, manejo e prognóstico

This Febrile seizure (FC) can be defined as a seizure in children aged between 6 and 60 months, with fever and who do not have intracranial infection, metabolic disorders or a previous history of afebrile seizure. It is the main cause of seizures in children and at least 4% of children in South America will develop it. This literature review searched for studies in the PubMed, Scielo and LILACS databases, using the descriptors "Febrile Seizures" and "febrile convulsion". 1902 studies were obtained, of which 09 were selected because they best addressed the chosen topic and were published in English or Portuguese. A febrile seizure can occur at any time during a febrile illness, but it usually occurs when the child reaches a temperature of over 38ºC. They are classified according to their duration, with those lasting less than 10-15 minutes being considered simple and those lasting longer being considered complex, which are more likely to recur and require hospitalization and the use of medication to control the seizures. The diagnosis is essentially clinical, but laboratory tests should be carried out to determine the cause of the fever and monitor the patient. In addition, imaging tests and electroencephalography should only be carried out in cases of neuronal involvement, which is rare. CF is a very common condition among children and is usually benign, but it causes great anxiety among the caregivers of affected children, and it is the doctor's role to reassure them and clearly explain the good prognosis.La convulsión febril (CF) puede definirse como una convulsión en niños de entre 6 y 60 meses, con fiebre y que no presentan infección intracraneal, trastornos metabólicos ni antecedentes de convulsión febril. Es la principal causa de convulsiones en niños y al menos el 4% de los niños en Sudamérica la desarrollarán. Esta revisión bibliográfica buscó estudios en las bases de datos PubMed, Scielo y LILACS, utilizando los descriptores "Febrile Seizures" y "febrile convulsion". Se obtuvieron 1902 estudios, de los cuales se seleccionaron 09 por ser los que mejor abordaban el tema elegido y estar publicados en inglés o portugués. Una convulsión febril puede ocurrir en cualquier momento durante una enfermedad febril, pero generalmente ocurre cuando el niño alcanza una temperatura superior a 38ºC. Se clasifican según su duración, considerándose simples las que duran menos de 10-15 minutos y complejas las que duran más tiempo, que tienen más probabilidades de repetirse y requieren hospitalización y el uso de medicación para controlar las convulsiones. El diagnóstico es esencialmente clínico, pero deben realizarse pruebas de laboratorio para determinar la causa de la fiebre y vigilar al paciente. Además, las pruebas de imagen y la electroencefalografía sólo deben realizarse en caso de afectación neuronal, que es poco frecuente. La FQ es una enfermedad muy frecuente entre los niños y suele ser benigna, pero causa gran ansiedad entre los cuidadores de los niños afectados, y es función del médico tranquilizarlos y explicarles claramente el buen pronóstico.Convulsão febril (CF) pode ser definida como uma convulsão em crianças com idade entre 6 e 60 meses, com febre e que não apresentam infecção intracraniana, distúrbios metabólicos ou história prévia de convulsão afebril. Ela é a principal causa de convulsão em crianças e pelo menos 4% das crianças da América do Sul a desenvolverão. Nessa revisão de literatura buscaram-se estudos nos bancos de dados do PubMed, Scielo e LILACS. Foram utilizados os descritores “Seizures Febrile” e “convulsão febril”, obtendo-se 1902 estudos, dos quais 09 foram selecionados por abordarem melhor o tema escolhido e serem publicados em inglês ou português. A convulsão febril pode se manifestar a qualquer momento da doença febril, mas ela costuma ocorrer quando a criança atinge temperaturas superiores a 38ºC. Ela é classificada quanto ao tempo de duração, sendo que aquelas com menos de 10-15 minutos são consideradas simples e com mais tempo são as complexas, sendo estas mais prováveis de recorrerem e de necessitarem de internação e do uso de medicamentos para controle das crises. O diagnóstico é essencialmente clínico, mas deve-se realizar exames laboratoriais para definição da causa da febre e acompanhamento do paciente. Além disso, exames de imagem e eletroencefalografia devem ser feitos apenas em casos de comprometimento neuronal, o que é raro. A CF é uma condição muito frequente entre as crianças e que costuma ser benigna, mas que gera grande ansiedade nos cuidadores das crianças que acometidas, sendo papel do médico tranquilizá-los e explicar de forma clara sobre o bom prognóstico.&nbsp

Gerenciamento Efetivo da Dermatite Atópica Estratégias de Tratamento e Prevenção de Complicações

Introduction: Atopic dermatitis (AD) is a chronic skin inflammation that begins in the first years of an individual's life as a result of an exacerbated immune response to certain agents, the main manifestation of which is intense itching of the skin. The prevalence of AD varies according to geographical region and climatic conditions. In Brazil, it is estimated that up to 20% of the pediatric population is affected by this pathology, with 60% of cases beginning in the first year of life. Objectives: To provide a comprehensive overview of atopic dermatitis (AD), from its pathophysiological foundations to the treatment options available. Methodology: This literature review searched PubMed, Scielo and LILACS databases, using the descriptors "Dermatitis, Atopic" AND "Etiology" AND "Physiopathology" AND "Diagnosis" AND "Treatment". 32 articles were selected because they best addressed the chosen topic. Results and Discussion: AD results from the interaction between genetic factors, skin barrier dysfunction and immunological alterations, as well as environmental factors. Deficiency of filaggrin, a crucial skin barrier protein, contributes to permeability to allergens and microorganisms, perpetuating skin inflammation. AD involves an exacerbated Th2 immune response, leading to IgE production and mast cell activation, exacerbating clinical symptoms. These consist of pruritus and chronic or recurrent lesions. In childhood, AD is characterized by erythema, papules, vesicles and crusts, mainly on the face and limbs. In the prepubertal phase, lesions in the flexural regions predominate, with lichenification. Diagnosis is clinical, based on specific criteria. In some cases, complementary tests may be necessary to rule out other skin conditions. Treatment is based on the use of emollients and topical therapies such as corticosteroids, as well as immunobiologicals in more severe cases. It is also important to identify environmental factors and allergens capable of triggering atopic dermatitis. Conclusion: AD is a complex dermatological condition influenced by genetic, immunological, environmental and dietary factors. Its prevalence is increasing, and early recognition of symptoms, patient and family education and appropriate treatment are extremely important.Introdução: A dermatite atópica (DA) é uma inflamação cutânea crônica que se inicia nos primeiros anos de vida do indivíduo, decorrente de resposta imune exacerbada a determinados agentes, tendo como principal manifestação o prurido intenso da pele. A prevalência da DA varia conforme a região geográfica e as condições climáticas. No Brasil, estima-se que até 20% da população pediátrica seja acometida por essa patologia, com 60% dos casos iniciando no primeiro ano de vida. Objetivos: Fornecer uma visão abrangente sobre a dermatite atópica (DA), abordando desde seus fundamentos fisiopatológicos até as opções de tratamento disponíveis. Metodologia: Nessa revisão de literatura buscaram-se estudos nos bancos de dados do PubMed, Scielo e LILACS. Foram utilizados os descritores “Dermatitis, Atopic” AND “Etiology” AND “Physiopathology” AND “Diagnosis” AND “Treatment”. Foram selecionados 32 artigos por abordarem melhor o tema escolhido. Resultados e Discussão: A DA resulta da interação entre fatores genéticos, disfunção da barreira cutânea e alterações imunológicas, além de fatores ambientais. A deficiência de filagrina, uma proteína crucial para a barreira cutânea, contribui para a permeabilidade a alérgenos e microrganismos, perpetuando a inflamação cutânea. A DA envolve uma resposta imunológica Th2 exacerbada, levando à produção de IgE e ativação de mastócitos, exacerbando os sintomas clínicos. Estes são compostos por prurido e lesões crônicas ou recidivantes. Na infância, a DA caracteriza-se por eritema, pápulas, vesículas e crostas, principalmente na face e membros. Já na fase pré-puberal, lesões nas regiões flexurais predominam, com liquenificação. O diagnóstico é clínico, baseado em critérios específicos. Em alguns casos, exames complementares podem ser necessários para descartar outras condições cutâneas. Seu tratamento visa o uso de emolientes e terapias tópicas, como corticosteroides, assim como imunobiológicos em casos mais graves. Também é importante identificar fatores ambientais e alérgenos capazes de desencadear a dermatite atópica. Conclusão: A DA é uma condição dermatológica complexa, influenciada por fatores genéticos, imunológicos, ambientais e alimentares. Sua prevalência tem aumentado, sendo extremamente importante o reconhecimento precoce dos sintomas, a educação dos pacientes e familiares e o tratamento adequado

Standard and Experimental Approach for Advanced Controls in Cryogenics

CERN, the European Organization for Nuclear Research, is one of the world's largest and most respected centres for scientific research. Its business is fundamental physics, finding out what the Universe is made of and how it works. At CERN, the world's largest and most complex scientific instruments are used to study the basic constituents of matter, the fundamental particles. By studying what happens when these particles collide, physicists learn about the laws of Nature. The instruments used at CERN are particle accelerators and detectors. Accelerators boost beams of particles to high energies before they are made to collide with each other or with stationary targets. Detectors observe and record the results of these collisions. The Large Hadron Collider (LHC) is the biggest and more powerful particle accelerator ever built. It is a circular particle accelerator with a circumference of 27 km, located about 100 m underground, used by physicists to study the smallest known particles, the fundamental building blocks of all things. Two beams of subatomic particles called hadrons", either protons or lead ions, travel in opposite directions inside the circular accelerator, gaining energy with every lap. The machine will be used to recreate the conditions just after the Big Bang, by colliding the two beams head-on at very high energy. Teams of physicists from around the world will analyse the particles created in the collisions usin g special detectors in a number of experiments dedicated to the LHC. The beams circulating in the LHC are accelerated by RF cavities to more than 99 % of the speed of light, thus reaching the nominal energy of 7 TeV per beam for a resulting overall nominal collision energy of 14 TeV . The beams intersect at the centre of the enormous detectors built to collect the results. The beams are bent and focused by means of a magnetic field produced by dipole and quadrupole magnets. The maximum field required in order to attain a stable beam with a sufficiently long life time reaches the peak of 8:33 T inside the dipoles, value reached by means of superconducting magnets whose Niobium-Titanium (NbTi) windings are cooled down to 1:9 K to allow the circulation of a nominal current of about 15 kA. In addition to that, also the safe and correct working of detectors and RF cavities need cryogenic temperatures. As a consequence, the operation of the accelerator requires cryogenic systems capable of reaching these extremely low temperatures. In particular, the LHC employs the world's biggest cryogenic installation with Helium as cooling uid, controlled by industrial Programmable Logic Controllers (PLCs). The realization of both installations and control systems constituted a great challenge, since for the first time cutting-edge technologies were employed on a complex large scale system. Motivations This thesis deals with the problem of mod eling and control applied to some of the cryogenic plants currently used at CERN, and exploits the experience accumulated over more than ten years on the construction, deployment and operation of the LHC cryogenic installations. A crucial point of the work lies in the mathematical modeling of the physical phenomena related to the cryogenic processes. In such systems, the superposition principle does not often hold true, because of the strong nonlinearities in the relations between causes acting on the system and their effects. In large scale installations such as those discussed in this work, the experimentation possibilities are strongly limited both by the costs and by the risks for the plants deriving from their realization. For this reason, in this thesis there will be an extensive use of simulation in the process of control design and simulation. Nonetheless, for the identication of the process under control it was exceptionally possible to carry out an experimental campaign on a Nitrogen heat exchanger. Furthermore, it is to be pointed out that in the above-described context, i.e. modeling and control applied to large scale nonlinear systems, also traditional well-established techniques may pose relevant problems for their practical application. In addition to that, new advanced techniques for modeling and control can be developed to optimize the management of the plants, with the purpose of increasing the performance of the controlled system in terms of fidelity to the desired behaviour, thus reducing undesired effects which could on the long term both increase operation costs and affect the availability of the system. Main contributions In reference to the aforementioned situation of the controls applied to large scale cryogenic installations, this thesis provides a twofold contribution: Within the frame of standard identication and control techniques, after a review of the state-of-the-art solutions proposed in literature, it shows what kind of problems these traditional approaches may pose when used in real large scale applications, and proposes a solution through the presentation of the activities carried out at CERN for parametric identification and control design of the ATLAS Nitrogen heat exchanger. In this way, a synthesis of scientific and industrial approaches is provided,in particular with reference to the implementation of the mathematical results in industrial controllers by means of Schneider PLC objects. It is worth mentioning that the heat exchanger is normally unavailable for experimentation, and that the practical work carried out on it was made possible only by an exceptional authorization granted to the author and his collaborators. This constitutes an unprecedented case study and one of the main contributions of this thesis. A novel approach to the control of cryogenic plants is proposed, including the phases of (i ) sys tem modeling through balance equations, describing mass ows and heat transfer evolution in the time domain under the assumption of spatial uniformity of the physical properties of interest, (ii ) control design and implementation, (iii )estimation of the parameters, namely communication time delays, employed by the control algorithm, and (iv ) results obtained thanks to the new approach in comparison with those of a traditional PID controller. The model is further improved in Appendix A, through the introduction of a more refined formulation of the equations taking into account variations of the physical properties both in the time and in the space domains. At the moment of closing this work, the modeling phase was still in progress and it was therefore impossible to include in this dissertation any related results. Anyway, this parts plays a central role among the contributions of the thesis, since it constitutes the starting point of further developments of the propose modeling and control approaches. Thesis overview This thesis is composed of four main parts, briefly described in the following. The first chapter introduces (i ) the basics of cryogenics, such as cryogenic uids, heat transfer theory, concepts of thermodynamics, and (ii ) cryogenic test facilities and detectors at CERN, including the ALTAS and CMS detectors, the central Helium liquefier and the Krypton calorimeter of the NA62 experiment. The second chapter gi ves an overview of the standard techniques used for system identification and control design, along with the results of the application of such techniques to the ATLAS Nitrogen heat exchanger. In particular, as far as the identification techniques are concerned, their goals and principles are illustrated, along with an overview of methods for signal post-processing, types of models, identication algorithms, and validation procedures. Subsequently, a state of the art on advanced control techniques is presented, including the Smith Predictor-based control, the Generalized Predictive Control, the Predictive Function Control, the R-S-T control. All these techniques are presented with a view to their industrial application, namely to their implementation on PLCs. In this perspective, the Advanced Automation Toolkit" from Mathworks and the MultiController Object" from the UNICOS framework are presented for (i ) model identication and validation, and (ii ) advanced control implementation, respectively, on industrial target platforms, namely Schneider PLCs. Finally, the results of the above-mentioned techniques applied to the identication and PID controller optimization in the ATLAS Nitrogen heat exchanger are presented and discussed. The third chapter presents a novel theoretical approach to modeling and control for large scale cryogenic systems, whose formulation is applied to the liquid Krypton condenser of the NA62 experiment. Firs t, a model is derived from balance equations in the form of ordinary differential equations (ODE) describing the mass flow and the heat transfer between cryogenic fluids. The modeling phase is followed by the proposal of an advanced control strategy, the Time Delay Control, whose performance obtained in simulation are presented in comparison with those of a more traditional PID-based control loop, thus showing the improvement allowed by the new approach. The implementation of the proposed solution required a further phase of analysis in order to satistically estimate the communication time delays usually encountered during the operation of the system under control. The results of these analysis are also presented. The fourth chapter presents the programming paradigm and the software tools currently used at CERN to handle the cryogenic plants. In particular, (i ) the object-based approach to industrial control, and (ii ) the UNICOS framework, developed inside the Organization in order to provide a unified platform for the management of all the cryogenic equipments, are discussed. As examples of application of the aforementioned programming paradigm,this part also provides information about the installation and commissioning of the refrigeration system for the CMS magnets, as well as about a simulation study for the virtual commissioning of the CERN central Helium liqueer. Finally, the off-line commissioning of the Helium cryogen ic plant and the operator training are discussed. In particular, a simulation environment is presented, which allows the training of the operators on large complex cryogenic systems, without any risk for the installations and any need to stop its normal operation. The thesis ends with the discussion of the conclusions drawn by the theoretical and practical work presented in the previous parts, along with an overview of the new perspectives it has opened. In particular, with regard to the future developments, a new modeling strategy for the NA62 condenser is introduced and developed in its basic aspects (Appendix A). This further improvement of the work proposed in the third part describes the phenomena occurring in the condenser through partial dierential equation, taking into account variations both in the time and in the space domains. Further investigation will be required to assess the possible benets deriving from this approach, and to check whether the additional complexity it introduces is balanced by significant improvements both in the model prediction accuracy and in the possible enhancements of the control strategy. In addition to that, further work will be devoted to the refinement of the simulation tools employed for the off-line commissioning of cryogenic plants and operator training. This task plays an important role in the frame of the future activities planned for the LHC,since the machine will be mostly used i n steady state operation for physic experiments and no time will be scheduled for operator training. In this scenario, highest importance will be given to the development of simulation tools giving the opportunity of (i ) training the operators without risks and stops for the installations, (ii ) improving the knowledge of cryogenic systems, and (iii ) saving an important time during plant re-starting by minimizing the probability of unexpected errors

Italo Gorini 2018

State of the art of research on cryogenics monitorin

Control of large helium cryogenic systems: a case study on CERN LHC

The CERN cryogenic facilities demand a versatile, distributed, homogeneous and highly reliable control system. For this purpose, CERN conceived and developed several frameworks (JCOP, UNICOS, FESA, CMW), based on current industrial technologies and COTS equipment, such as PC, PLC and SCADA systems complying with the requested constraints. The cryogenic control system nowadays uses these frameworks and allows the joint development of supervision and control layers by defining a common structure for specifications and code documentation. Another important advantage of the CERN frameworks is the possibility to integrate different control systems into a large technical system with communication capability. Such a system is capable of sharing control variables from all accelerator apparatus in order to cope with the operation scenarios.The first implementation of this control architecture started in 2000 for the Large Hadron Collider (LHC). Since then CERN continued developing the hardware and software components of the cryogenic control system, based on the exploitation of the experience gained. These developments are always aimed at increasing the safety and improving the performance. To overcome the long-term maintenance challenges, key strategies such as the use of homogeneous hardware solutions and the optimization of the maintenance procedures were set up. They are easing the development of the control applications and the hardware configuration by allowing a structured and homogeneous approach. Furthermore, they reduce the needed manpower and minimize the financial impact of the periodical maintenance. In that context, the standardization of technical solutions both at hardware and software level simplify also the systems monitoring the operation and maintenance processes, while providing a high level of availability

Bike2Work "Critical Mass" event

Start from Restaurant 2 and biking to Restaurant 1 via Route Fermi

CERN Cryogenic Controls Today and Tomorrow

The CERN cryogenic facilities demand a versatile, distributed, homogeneous and highly reliable control system. For this purpose, CERN conceived and developed several frameworks (JCOP, UNICOS, FESA, CMW), based on current industrial technologies and COTS equipment, such as PC, PLC and SCADA systems complying with the requested constraints. The cryogenic control system nowadays uses these frameworks and allows the joint development of supervision and control layers by defining a common structure for specifications and code documentation. Such a system is capable of sharing control variable from all accelerator apparatus. The first implementation of this control architecture started in 2000 for the Large Hadron Collider (LHC). Since then CERN continued developing the hardware and software components of the cryogenic control system, based on the exploitation of the experience gained. These developments are always aimed to increase the safety and to improve the performance. The final part will present the evolution of the cryogenic control toward an integrated control system SOA based CERN using the Reference Architectural Model Industrie 4.0 (RAMI 4.0)

Approche standard et expérimentale pour le contrôle avancé appliqué à la cryogénie

Cette thèse présente la problématique des modèles et des systèmes de contrôle appliqués à certaines installations cryogéniques utilisées au CERN et exploite l'expérience accumulée pendant plus de dix ans lors de la construction, du développement et de la mise en route des installations cryogéniques du LHC. La première partie introduit (i) les bases de la cryogénie, tels les fluides cryogéniques, la théorie de transfert de chaleur, le concept de thermodynamique, (ii) les installations de test cryogéniques et les détecteurs au CERN. La deuxième partie donne une vue d'ensemble des techniques standards utilisées pour l'identification du système et la conception des lois de commande. La troisième partie présente une nouvelle approche théorique à la modélisation et au contrôle pour des systèmes cryogéniques à grande échelle, dont la formulation est appliquée sur le condensateur liquide à Krypton de l'expérience NA62. Premièrement, un modèle est dérivé d'équations de bilan sous la forme d'équations différentielles ordinaires (ODE) qui décrivent le flux de masse et le transfert de chaleur entre des fluides cryogéniques. La phase de modélisation est suivie d'une proposition d'une stratégie de contrôle avancé, le Time Delay Control, dont les performances, obtenues en simulation, est présentée en comparant avec les performances d'une boucle de régulation plus traditionnelle (correction PID). L'implémentation de la solution proposée a demandé une phase d'analyse plus approfondie afin d'estimer statistiquement les délais de communication rencontrés lors de la mise en marche du système ainsi contrôlé. La quatrième partie présente les principes de programmation et les outils informatiques actuellement utilisés au CERN pour gérer les installations cryogéniques.Pour terminer l'étude, des conclusions sont données à partir du travail théorique et pratique présenté avec une vue d'ensemble des nouvelles perspectives ouvertes par celui-ci.This thesis deals with the problem of modeling and control applied to some of the cryogenic plants currently used at CERN, and exploits the experience accumulated over more than ten years on the construction, deployment and operation of the LHC cryogenic installations. The first chapter introduces (i) the basics of cryogenics, such as cryogenic fluids, heat transfer theory, concepts of thermodynamics, and (ii) cryogenic test facilities and detectors at CERN. The second chapter gives an overview of the standard techniques used for system identification and control design. The third chapter presents a novel theoretical approach to modeling and control for large scale cryogenic systems, whose formulation is applied to the liquid Krypton condenser of the NA62 experiment. First, a model is derived from balance equations in the form of ordinary differential equations (ODE) describing the mass flow and the heat transfer between cryogenic fluids. The modeling phase is followed by the proposal of an advanced control strategy, the Time Delay Control, whose performances obtained in simulation are presented in comparison with those of a more traditional PID-based control loop, thus showing the improvement allowed by the new approach. The implementation of the proposed solution required a further phase of analysis in order to statistically estimate the communication time delays usually encountered during the operation of the system under control. The results of these analyses are also presented. The fourth chapter presents the programming paradigm and the software tools currently used at CERN to handle the cryogenic plants. The thesis ends with the discussion of the conclusions drawn by the theoretical and practical work presented in the previous parts, along with an overview of the new perspectives it has opened.AMIENS-BU Sciences (800212103) / SudocSudocFranceF

Active Magnetic Bearings System Upgrade for LHC Cryogenic Cold Compressor, Radiations Mitigation Project (R2E)

During the normal operation of the Large Hadron Collider, the high hadron flux level induced several Single Event Errors (SEE failure caused by a particle passing through) to the standard electronics installed. Such events perturbed LHC normal operation. As a consequence, a mitigation plan to minimise radiation-induced failures and optimise LHC operation was started: R2E mitigation project. This paper will deal with the mitigation problem for LHC/P8 equipment and the main improvements for the equipment in P4, with special focus on the controllers for the Active Magnetic Bearings used in the IHI-LINDE cold compressors. In addition, a new approach based on frequency response analysis to assess the cold compressor mechanical quality will be presented. The hardware and software design, implemented to increase the global reliability of the system, will be highlighted. A corresponding experiment protocol was developed at CERN in collaboration with the MECOS Company and the Universities of Sannio and Napoli Federico II. Preliminary experimental results showing the performance of the proposed approach on a case study for the cold compressor in P4 will be finally reported

Cryogenic systems: advanced monitoring, fault diagnostics, and predictive maintenance

Cryogenics, the study and technology of materials and systems at very low temperature, is widely used for sensors and instruments requiring very highly precise measurements with low electrical resistance, especially for measurements of materials and energies at a very small scale. Thus, the need to understand how instruments operate and perform over time at temperatures below -2920 F (-1800 C) is critical, for applications from Magnetic Resonance Imaging (MRI) to Nuclear Magnetic Resonance Spectroscopy to instrumentation for particle accelerators of all kinds. This book brings to the reader guidance learned from work at the European Laboratory for Nuclear Research (CERN), and its large scale particle accelerator in Switzerland to help engineers and technicians implement best practices in instrumentation at cryogenic temperatures, including a better understanding of fault detection and predictive maintenance. Special problems with devices like flow meters, pressure gauges, and temperature gauges when operating at cryogenic temperatures is discussed. References for further reading and research will also be offered