Reducción del Riesgo en Equipos Biomédicos y en Instalaciones Eléctricas de Entornos Clínicos / Risk Reduction in Electrical Networks and Safety of Biomedical Equipment in Clinical Settings

Resumen Se analizan 112 auditorías de instalaciones eléctricas y seguridad de equipos biomédicos en 78 Institutos de Medicina Altamente Especializada (IMAE) del Uruguay, realizadas a lo largo de 14 años, clasificando el nivel de riesgo y de cumplimiento de normas desde el punto de vista de Ingeniería Clínica. Cada visita incluye una encuesta al personal encargado de mantener y gestionar la infraestructura eléctrica y el equipamiento biomédico, que abarca el estado de mantenimiento, el control y la documentación de las instalaciones eléctricas y del equipamiento biomédico. Se evalúa el riesgo con un puntaje de 0 a 4. En 2004-2007 el 74% de los IMAE tenía irregularidades en la instalación eléctrica, gestión de equipamiento, control de calidad o documentación. Además, un 15% de los que tenían problemas, tenía en particular equipamiento indicado como "equipo peligroso". En los períodos siguientes esta proporción baja paulatinamente hasta 0% en 2016-2017. No obstante, continúa existiendo un déficit en la gestión del equipamiento y en la documentación formal. El aporte de la Universidad en el seguimiento técnico de los IMAE se ha materializado en una mejora en materia de seguridad.

Abstract 112 field inspections to 78 high technology medical centers (IMAE is the Spanish acronym) over 14 years are analyzed. All visits were evaluated as to Clinical Engineering good practices and were assigned a risk level. All audits included a questionaire to maintenance management personnel on electrical network operation as well as on biomedical equipment follow-up and documentation from acquisition to disposal. Risk is assigned a level 0 to 4 at each visit. In 2004-2007, 74% of IMAEs had safety problems in one or more of electrical network, maintenance management or documentation, and 15% of the IMAEs with safety problems had one piece of equipment described as simply "dangerous". Electrical safety problems were eventually reduced to 0% in 2016-2017, probably as a consequence of regular audit and counseling by this University Clinical Engineering Program.

OSPRay - A CPU Ray Tracing Framework for Scientific Visualization.

Scientific data is continually increasing in complexity, variety and size, making efficient visualization and specifically rendering an ongoing challenge. Traditional rasterization-based visualization approaches encounter performance and quality limitations, particularly in HPC environments without dedicated rendering hardware. In this paper, we present OSPRay, a turn-key CPU ray tracing framework oriented towards production-use scientific visualization which can utilize varying SIMD widths and multiple device backends found across diverse HPC resources. This framework provides a high-quality, efficient CPU-based solution for typical visualization workloads, which has already been integrated into several prevalent visualization packages. We show that this system delivers the performance, high-level API simplicity, and modular device support needed to provide a compelling new rendering framework for implementing efficient scientific visualization workflows.

Selective prevention of combat-related post-traumatic stress disorder using attention bias modification training: a randomized controlled trial.

BACKGROUND: Efficacy of pre-trauma prevention for post-traumatic stress disorder (PTSD) has not yet been established in a randomized controlled trial. Attention bias modification training (ABMT), a computerized intervention, is thought to mitigate stress-related symptoms by targeting disruptions in threat monitoring. We examined the efficacy of ABMT delivered before combat in mitigating risk for PTSD following combat. METHOD: We conducted a double-blind, four-arm randomized controlled trial of 719 infantry soldiers to compare the efficacy of eight sessions of ABMT (n = 179), four sessions of ABMT (n = 184), four sessions of attention control training (ACT; n = 180), or no-training control (n = 176). Outcome symptoms were measured at baseline, 6-month follow-up, 10 days following combat exposure, and 4 months following combat. Primary outcome was PTSD prevalence 4 months post-combat determined in a clinical interview using the Clinician-Administered PTSD Scale. Secondary outcomes were self-reported PTSD and depression symptoms, collected at all four assessments. RESULTS: PTSD prevalence 4 months post-combat was 7.8% in the no-training control group, 6.7% with eight-session ABMT, 2.6% with four-session ABMT, and 5% with ACT. Four sessions of ABMT reduced risk for PTSD relative to the no-training condition (odds ratio 3.13, 95% confidence interval 1.01-9.22, p < 0.05, number needed to treat = 19.2). No other between-group differences were found. The results were consistent across a variety of analytic techniques and data imputation approaches. CONCLUSIONS: Four sessions of ABMT, delivered prior to combat deployment, mitigated PTSD risk following combat exposure. Given its low cost and high scalability potential, and observed number needed to treat, research into larger-scale applications is warranted. The ClinicalTrials.gov identifier is NCT01723215.

A neurobehavioral account for individual differences in resilience to chronic military stress.

BACKGROUND: Military training is a chronic stressful period that often induces stress-related psychopathology. Stress vulnerability and resilience depend on personality trait anxiety, attentional threat bias and prefrontal-limbic dysfunction. However, how these neurobehavioral elements interact with regard to the development of symptoms following stress remains unclear. METHOD: Fifty-five healthy combat soldiers undergoing intensive military training completed functional magnetic resonance imaging (fMRI) testing while performing the dot-probe task (DPT) composed of angry (threat) and neutral faces. Participants were then stratified according to their bias tendency to avoidance (n = 25) or vigilance (n = 30) groups, categorized as high or low trait anxiety and assessed for post-stress symptom severity. RESULTS: Avoidance compared to vigilance tendency was associated with fewer post-trauma symptoms and increased hippocampal response to threat among high anxious but not low anxious individuals. Importantly, mediation analysis revealed that only among high anxious individuals did hippocampal activity lead to lower levels of symptoms through avoidance bias tendency. However, in the whole group, avoidance bias was modulated by the interplay between the hippocampus and the dorsal anterior cingulate cortex (dACC). CONCLUSIONS: Our results provide a neurobehavioral model to explain the resilience to post-trauma symptoms following chronic exposure. The model points to the importance of considering threat bias tendency in addition to personality traits when investigating the brain response and symptoms of trauma. Such a multi-parametric approach that accounts for individual behavioral sensitivities may also improve brain-driven treatments of anxiety, possibly by targeting the interplay between the hippocampus and the dACC.

Perturbed threat monitoring following a traumatic event predicts risk for post-traumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a chronic and difficult to treat psychiatric disorder. Objective, performance-based diagnostic markers that uniquely index risk for PTSD above and beyond subjective self-report markers could inform attempts to improve prevention and early intervention. We evaluated the predictive value of threat-related attention bias measured immediately after a potentially traumatic event, as a risk marker for PTSD at a 3-month follow-up. We measured the predictive contribution of attentional threat bias above and beyond that of the more established marker of risk for PTSD, self-reported psychological dissociation. METHOD: Dissociation symptoms and threat-related attention bias were measured in 577 motor vehicle accident (MVA) survivors (mean age = 35.02 years, 356 males) within 24 h of admission to an emergency department (ED) of a large urban hospital. PTSD symptoms were assessed at a 3-month follow-up using the Clinician-Administered PTSD Scale (CAPS). RESULTS: Self-reported dissociation symptoms significantly accounted for 16% of the variance in PTSD at follow-up, and attention bias toward threat significantly accounted for an additional 4% of the variance in PTSD. CONCLUSIONS: Threat-related attention bias can be reliably measured in the context of a hospital ED and significantly predicts risk for later PTSD. Possible mechanisms underlying the association between threat bias following a potentially traumatic event and risk for PTSD are discussed. The potential application of an attention bias modification treatment (ABMT) tailored to reduce risk for PTSD is suggested.

Fast Construction of SAH BVHs on the Intel Many Integrated Core (MIC) Architecture.

We investigate how to efficiently build bounding volume hierarchies (BVHs) with surface area heuristic (SAH) on the Intel Many Integrated Core (MIC) Architecture. To achieve maximum performance, we use four key concepts: progressive 10-bit quantization to reduce cache footprint with negligible loss in BVH quality; an AoSoA data layout that allows efficient streaming and SIMD processing; high-performance SIMD kernels for binning and partitioning; and a parallelization framework with several build-specific optimizations. The resulting system is more than an order of magnitude faster than today's high-end GPU builders for comparable BVHs; it is usually faster even than spatial median builders; it can build SAH BVHs almost as fast as existing GPUs and CPUs- and CPU-based approaches can build regular grids; and in aggregate "build+render" performance is significantly faster than the best published numbers for either of these systems, be it CPU or GPU, BVH, kd-tree, or grid.

Attention bias away from threat during life threatening danger predicts PTSD symptoms at one-year follow-up.

BACKGROUND: Recent studies find a correlation between attentional threat avoidance under stress and posttraumatic stress symptoms. In this study, we assessed this association longitudinally in exposed and unexposed individuals. The degree of threat avoidance during exposure was expected to predict levels of posttraumatic stress symptoms 1 year later. METHODS: Thirty-two participants were recruited and followed for 12 months, including 18 subjects exposed to rocket attacks and 14 nonexposed subjects. At 1-year follow-up, participants completed self-reports and an attention dot-probe task assessing threat-related bias. RESULTS: State anxiety decreased at follow-up in exposed participants, though posttraumatic stress disorder (PTSD) and depression symptoms remained higher in exposed than in the nonexposed group. Attentional threat avoidance during imminent danger in the exposed group changed to threat attendance a year later, such that both the exposed and the nonexposed group exhibited similar threat bias patterns. As hypothesized, in the exposed group, stronger attentional threat avoidance during stress exposure predicted higher levels of PTSD symptoms 1 year later. CONCLUSIONS: Attention bias away from threat during acute stress may relate to risk for PTSD. This suggests that neurocognitive measures may index risk for PTSD.

Battlefield-like stress following simulated combat and suppression of attention bias to threat.

BACKGROUND: Acute stress disorder involves prominent symptoms of threat avoidance. Preliminary cross-sectional data suggest that such threat-avoidance symptoms may also manifest cognitively, as attentional threat avoidance. Confirming these findings in a longitudinal study might provide insights on risk prediction and anxiety prevention in traumatic exposures. METHOD: Attention-threat bias and post-traumatic symptoms were assessed in soldiers at two points in time: early in basic training and 23 weeks later, during advanced combat training. Based on random assignment, the timing of the repeat assessment occurred in one of two schedules: for a combat simulation group, the repeat assessment occurred immediately following a battlefield simulation exercise, and for a control group, the assessment occurred shortly before this exercise. RESULTS: Both groups showed no threat-related attention bias at initial assessments. Following acute stress, the combat simulation group exhibited a shift in attention away from threat whereas the control group showed no change in attention bias. Stronger threat avoidance in the combat simulation group correlated with severity of post-traumatic symptoms. Such an association was not found in the control group. CONCLUSIONS: Acute stress may lead some individuals to shift their attention away from threats, perhaps to minimize stress exposure. This acute attention response may come at a psychological cost, given that it correlates with post-traumatic stress disorder (PTSD) symptoms. Further research is needed to determine how these associations relate to full-blown PTSD in soldier and civilian populations.

Follow-up studies of a representative sample of children with severe mental handicap in Poland.

A representative sample of 260 Polish children, aged 5-14 years, identified between 1964 and 1965 in an epidemiological study as severely mentally handicapped (IQs ranging from 0 to 51) were followed up twice: (I) after 10 years (in 1975-1976); and (II) after 23 years (in 1987-1988). At both follow-ups, all surviving subjects were contacted, and psychological and sociological data were gathered; the findings presented here pertain mostly to follow-up II. The great majority of subjects (85%) lived with their families, and the remainder resided in an institution. Only 10% of subjects (living with one exception in families) currently had a higher level of intellectual functioning than that of severe mental handicap. Among this group were individuals of relatively better health, without speech disorders, who had attended schools, had some vocational training, had been or were employed, and had families of their own, i.e. were self-dependent with a life-style similar to that of other people of their age and social background. Of the remainder, about 40% retained the same relative level of intellectual and social functioning, and about 50% deteriorated, particularly those in institutions. This latter group has remained in the role of permanent children, depending on others for care and maintenance.

Acute chest syndrome in children with sickle cell anemia.

Vaso-occlusive crisis is the most common cause of morbidity in patients with sickle cell anemia (SCA). Those patients are frequently admitted with chest signs and symptoms suggesting an infective process. The term acute chest syndrome (ACS) is used to describe those chest episodes in SCA patients, and it is postulated that a primary bone vaso-occlusive crisis may be the cause of the acute chest syndrome in SCA patients. In this study we report 52 episodes of ACS in a group of 22 children with SCA. Chest pain, fever, and leukocytosis were a constant clinical finding. The hematological, radiological, and bacteriological studies are reported. There is a constant and significant fall in hemoglobin levels from 88 +/- 10 g/L (8.8 +/- 1.0 g/dl) to 68 +/- 15 g/L (6.8 +/- 5 g/dl). Unilateral or bilateral pulmonary basal infiltrations were found in 50 episodes. Pleural effusion was noticed in 60 episodes, and it was bilateral in three. No significant bacteriological findings were present.

Mapping the human genes.

The article recalls achievements in the area of human gene mapping and covers recent developments in somatic cell hybridization studies and recombinant DNA technology.

Low molecular weight copper binding proteins in Wilson disease.

Cultured fibroblasts deriving from Wilson disease patients were compared with the control ones in respect of copper accumulation and low molecular weight copper binding protein (metallothionein) properties. No evidence was obtained that metallothionein abnormality could be a primary cause of copper metabolism disturbances in Wilson disease. The determination of radioactivity, present in serum low molecular weight fraction 24 hours after intravenous injection of 64Cu, has been suggested as an additional tool in Wilson disease diagnosis in doubtful cases.

Alcohol consumption and alcoholic psychoses in Poland.

In Poland, analysis of partial correlations showed a close connection of the incidence of alcoholic psychoses with total alcohol consumption and consumption of distilled spirits but not with consumption of wine or beer. It is suggested that the incidence of alcoholic psychoses can serve as an indicator of the incidence of alcohol-related problems.