RESUMEN
Absolute distance determination in the open air with an uncertainty of a few tenths of a millimetre is increasingly required in many applications that involve high precision geodetic metrology. No matter the technique used to measure, the resulting distances must be proven consistent with the unit of length (SI-metre) as realized in the outdoor facilities traditionally used in length metrology, which are also known as calibration baselines of reference. The current calibration baselines of reference have distances in the range of 10 to 1000 m, but at present there is no solution on the market to provide distances with submillimetric precision in that range. Consequently, new techniques such as multi-wave interferometry, two-wave laser telemeters or laser trackers are being developed. A possible alternative to those sophisticated and expensive techniques is the use of widely used Global Navigation Satellite Systems (GNSS) in order to provide a GNSS-Based Distance Meter (GBDM). The use of a GBDM as a potential technique for length metrology has been thoroughly analysed in several European research projects by using the state-of-the-art geodetic software, such as Bernese 5.2, but no definite conclusions have been drawn and some metrological questions are considered still open. In this paper, we describe a dedicated approach to build up a submillimetric GBDM able to be applied in the current calibration baselines of reference, as well as possible methods to cope with the multipath error of the GNSS signals which is the major limitation for the practical uptaking of the technique in metrology. The accuracy of the proposed approach has been tested following the length metrology standards in four experiments carried out in the Universitat Politècnica de València (UPV). The results demonstrate that the proposed GBDM can provide an accuracy of a few tenths of a millimetre in the current calibration baselines of reference.
RESUMEN
BACKGROUND: Current guidelines recommend palliative care based on individual needs for patients with idiopathic pulmonary fibrosis. However, patients with interstitial lung disease (ILD) are less likely to receive specialist palliative care services compared with patients with malignant disease. The aim of this review is to summarise recent studies addressing barriers to referring patients to specialist palliative care services. METHODS: PubMed, Embase, Medline and Web of Science were reviewed to identify relevant publications. Studies were selected if they examined the frequency of specialist palliative care referral and/or addressed issues surrounding access to palliative care services for patients with ILD. RESULTS: Ten studies with a total of 4073 people with ILD, 27 caregivers and 18 healthcare professionals were selected and analysed. Frequency of palliative care referrals ranged from 0% to 38%. Delay in palliative care referrals and end-of-life decisions, patients' fear of talking about the future, prognostic uncertainty and confusion about the roles of palliative care were identified as barriers to accessing palliative care services. CONCLUSION: Further research should concentrate on the early identification of patients who need specialist palliative care possibly with establishment of criteria to trigger referral ensuring that referrals are also based on patient's needs.
Asunto(s)
Atención a la Salud/normas , Enfermería de Cuidados Paliativos al Final de la Vida/normas , Fibrosis Pulmonar Idiopática/enfermería , Enfermedades Pulmonares Intersticiales/enfermería , Enfermeras Clínicas/normas , Cuidados Paliativos/normas , Derivación y Consulta/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Patients with traumatic bladder rupture frequently have associated pelvic fracture. With increasing numbers of pelvic fractures fixed internally, there are concerns that conservative management of bladder rupture may increase the risk of pelvic metalware infection. This study aims to determine if operative repair of bladder rupture in comparison to conservative management with catheter drainage alone is associated with a lower rate of infection of internal fixation device for concurrent pelvic fracture. METHODS: This is a retrospective cohort study of level IV evidence. From July 2001 through June 2013, 45 multi-trauma patients at a level 1 trauma centre were identified to have sustained bladder rupture with concurrent pelvic fracture requiring internal fixation. Clinicopathological data were extracted from the TraumaNET database, medical records and health-coding database. Patients were stratified into two retrospective cohorts, management with surgical repair and management with catheter drainage alone. Fischer's exact test was used to determine whether the rate of pelvic metalware infection was different in the two cohorts. RESULTS: Of the 45 patients, 13 had intraperitoneal bladder rupture, 28 had extraperitoneal bladder rupture and four had combined intra-extraperitoneal bladder rupture. The median age for this cohort was 31. Bladder rupture was surgically repaired in 36 patients and managed conservatively with catheter drainage in nine patients. The rate of pelvic internal fixation device infection was lower in patients managed with surgical repair compared with conservative management (5.6% versus 33.3%, P = 0.047). CONCLUSION: Operative repair of bladder rupture is associated with a lower rate of pelvic orthopaedic hardware infection in the presence of concurrent pelvic fracture requiring internal fixation.
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Fijación Interna de Fracturas/métodos , Fijadores Internos/efectos adversos , Huesos Pélvicos/lesiones , Infecciones Relacionadas con Prótesis/epidemiología , Rotura/cirugía , Vejiga Urinaria/lesiones , Adulto , Estudios de Cohortes , Tratamiento Conservador/métodos , Cistoscopía/métodos , Femenino , Fijación Interna de Fracturas/efectos adversos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Humanos , Incidencia , Fijadores Internos/microbiología , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/cirugía , Huesos Pélvicos/cirugía , Valor Predictivo de las Pruebas , Pronóstico , Infecciones Relacionadas con Prótesis/prevención & control , Estudios Retrospectivos , Medición de Riesgo , Rotura/diagnóstico por imagen , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos X/métodos , Centros Traumatológicos , Resultado del Tratamiento , Vejiga Urinaria/cirugíaRESUMEN
Fatigue is a common manifestation of sarcoidosis, often persisting without evidence of disease activity. First-line therapies for sarcoidosis have limited effect on fatigue. This review aimed to assess the treatment options targeting sarcoidosis-associated fatigue. Medline and Web of Science were searched in November 2015; the bibliographies of these papers, and relevant review papers, were also searched. Studies were included if they reported on the efficacy of interventions (both pharmacological and non-pharmacological) on fatigue scores in sarcoidosis patients. Eight studies were identified that fulfilled the inclusion criteria. These studies evaluated six different interventions (infliximab, adalimumab, ARA 290, methylphenidate, armodafinil and exercise programmes). There is evidence to support a treatment effect of anti-tumour necrosis factor (TNF)-αtherapies (adalimumab and infliximab) and neurostimulants (methylphenidate and armodafinil), but within five of the studies, the risk of bias was high within most domains and the remaining three studies included only small numbers of participants and were short in duration. Trial evidence for treating fatigue as a manifestation of sarcoidosis is limited and requires further investigation. Anti-TNF-α therapies may be beneficial in patients with organ-threatening disease. Neurostimulants have some trial evidence supporting improvements in fatigue but further investigation is needed before they can be recommended.
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Estimulantes del Sistema Nervioso Central/uso terapéutico , Terapia por Ejercicio , Fatiga/terapia , Sarcoidosis/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab/uso terapéutico , Antirreumáticos/uso terapéutico , Compuestos de Bencidrilo/uso terapéutico , Fatiga/etiología , Humanos , Infliximab/uso terapéutico , Metilfenidato/uso terapéutico , Modafinilo , Oligopéptidos/uso terapéutico , Sarcoidosis/complicacionesRESUMEN
We report measurements which give direct insight into the origins of the transparency current for λ ~5 µm In0.6Ga0.4As/In0.42Al0.58As quantum cascade lasers in the temperature range of 80-280 K. The transparency current values have been found from broadband transmission measurements through the laser waveguides under sub-threshold operating conditions. Two active region designs were compared. The active region of the first laser is based on double-LO-phonon relaxation approach, while the second device has only one lower level, without specially designed resonant LO-phonon assisted depopulation. It is shown that transparency current contributes more than 70% to the magnitude of threshold current at high temperatures for both designs.
Asunto(s)
Rayos Láser , Espectrofotometría Infrarroja/instrumentación , Resonancia por Plasmón de Superficie/instrumentación , Diseño Asistido por Computadora , Diseño de Equipo , Análisis de Falla de Equipo , Rayos Infrarrojos , Teoría CuánticaRESUMEN
Cultures of dissociated foetal and postnatal mouse gut gave rise to neurosphere-like bodies, which contained large numbers of mature neurons and glial cells. In addition to differentiated cells, neurosphere-like bodies included proliferating progenitors which, when cultured at clonal densities, gave rise to colonies containing many of the neuronal subtypes and glial cells present in the mammalian enteric nervous system. These progenitors were also capable of colonising wild-type and aganglionic gut in organ culture and had the potential to generate differentiated progeny that localised within the intrinsic ganglionic plexus. Similar progenitors were also derived from the normoganglionic small intestine of mice with colonic aganglionosis. Our findings establish the feasibility of expanding and isolating early progenitors of the enteric nervous system based on their ability to form distinct neurogenic and gliogenic structures in culture. Furthermore, these experiments provide the rationale for the development of novel approaches to the treatment of congenital megacolon (Hirschsprung's disease) based on the colonisation of the aganglionic gut with progenitors derived from normoganglionic bowel segments.