The "Heart Area" of Juan Canalejo Hospital Complex. A new approach to clinical management

The present work describes the process by which the pilot project of clinical management of the Hospital Complex Juan Canalejo, designated as "Heart Area", was implemented. In the first section, the needs and reasons that led to the undertaking of this project are explained. The project's objectives and operative strategies are listed. In the Material and Methods section, three basic aspects of the "Heart Area" are described: selection criteria of the "Area", its structure and function, and its foundation and development. In the Results section, we compare the activity undertaken in the "Area" to the situation present prior to its implementation, in relation to quality and costs. Finally, in the Conclusions, we comment on the important implications that our project can have within the Hospital Complex Juan Canalejo as well as in the health care field in general.     

Transmembrane passage of cytokine-inducing bacterial products across new and reprocessed polysulfone dialyzers

The widespread use of bicarbonate dialysate and reprocessed high-efficiency and "high-flux" dialyzers has raised concerns about the increased risk of reverse-transfer of dialysate contaminants into the blood compartment. To evaluate this concern, the reverse-transfer of bacterial products from contaminated bicarbonate dialysate into the blood compartment was compared during in vitro dialysis with new or reprocessed high-flux polysulfone dialyzers. In vitro dialysis was carried out at 37 degrees C by use of a counter-current recirculating loop dialysis circuit with either new high-flux polysulfone dialyzers or dialyzers reprocessed once or 20 times with formaldehyde (0.75%) and bleach (< 1%) with an automated system. Heparinized whole blood from healthy volunteers was circulated through the blood compartment, and bicarbonate dialysate was circulated in the dialysate compartment. The dialysate was challenged sequentially by 1:1000 and 1:100 dilutions of a sterile Pseudomonas aeruginosa culture supernatant (bacterial challenge). Samples were drawn from the blood and dialysate compartments 1 h after each challenge. Peripheral blood mononuclear cells (PBMC) were harvested by Ficoll-Hypaque separation from whole blood in the blood compartment and a 5 x 10(6) PBMC/mL cell suspension was prepared. Likewise, dialysate samples (0.5 mL) were added to 0.5 mL suspension of 5 x 10(6) PBMC/mL drawn at baseline. All PBMC suspensions were incubated upright in a humidified atmosphere at 37 degrees C with 5% CO2 for 24 h, and total interleukin-1 alpha (IL-1 alpha) and tumor necrosis factor-alpha (TNF alpha) cytokine production (cell-associated and secreted) was measured by radioimmunoassay. Eight experiments were performed for each arm of the study with the same donor for each arm. One hour after contaminating the dialysate with a 1:1000 dilution of the bacterial challenge, IL-1 alpha production by PBMC harvested from the blood compartment was 160 +/- 0, 171 +/- 11, and 270 +/- 35 pg, respectively, for new dialyzers, dialyzers reprocessed once, and dialyzers reprocessed 20 times (P = 0.004). One hour after challenging the dialysate with 1:100 dilution, IL-1 alpha production by PBMC harvested from the blood compartment was 188 +/- 20, 228 +/- 35, and 427 +/- 67 pg, respectively, for new dialyzers, dialyzers reprocessed once, and dialyzers reprocessed 20 times (P = 0.006). IL-1 alpha production by PBMC from dialyzers reprocessed 20 times was significantly greater than both new and dialyzers reprocessed once. However, there were no significant differences between new dialyzers and dialyzers reprocessed once. Similarly, after the 1:1000 challenge, TNF alpha production by PBMC harvested from the blood compartment was 160 +/- 0, 160 +/- 0, and 213 +/- 22 pg, respectively, for new dialyzers, dialyzers reprocessed once, and dialyzers reprocessed 20 times (P = 0.008). After the 1:100 challenge, TNF alpha production was 168 +/- 8, 188 +/- 20, and 225 +/- 32 pg, respectively, for new dialyzers, dialyzers reprocessed once, and dialyzers reprocessed 20 times (P = 0.20). These results demonstrate that reprocessing of high-flux polysulfone dialyzers with bleach increases the risk of reverse-transfer of bacterial products from contaminated dialysate, and this risk appears to increase with the number of reuses. Consequently, units that reprocess membranes with bleach and have suboptimal water quality might subject their patients to a higher risk of cytokine-related morbidity.     

Solving identity delegation problem in the e-government environment

At present, many countries allow citizens or entities to interact with the government outside the telematic environment through a legal representative who is granted powers of representation. However, if the interaction takes place through the Internet, only primitive mechanisms of representation are available, and these are mainly based on non-dynamic offline processes that do not enable quick and easy identity delegation. This paper proposes a system of dynamic delegation of identity between two generic entities that can solve the problem of delegated access to the telematic services provided by public authorities. The solution herein is based on the generation of a delegation token created from a proxy certificate that allows the delegating entity to delegate identity to another on the basis of a subset of its attributes as delegator, while also establishing in the delegation token itself restrictions on the services accessible to the delegated entity and the validity period of delegation. Further, the paper presents the mechanisms needed to either revoke a delegation token or to check whether a delegation token has been revoked. Implications for theory and practice and suggestions for future research are discussed.     

Consequences and conjectures in preordered sets

In a preordered set, or preset, consequence operators in the sense of Tarski, defined on families of subsets, are introduced. From them, the corresponding sets of conjectures, hypotheses, speculations and refutations are considered, studying the relationships between these sets and those previously defined on ortholattices. All the concepts introduced are illustrated with three particular consequence operators, whose behavior is studied in detail. The results obtained are applied to the case of fuzzy sets endowed with the usual pointwise ordering.     

Observation strategies for event detection with incidence on runtime verification: theory, algorithms, experimentation

Many applications (such as system and user monitoring, runtime verification, diagnosis, observation-based decision making, intention recognition) all require to detect the occurrence of an event in a system, which entails the ability to observe the system. Observation can be costly, so it makes sense to try and reduce the number of observations, without losing full certainty about the event??s actual occurrence. In this paper, we propose a formalization of this problem. We formally show that, whenever the event to be detected follows a discrete spatial or temporal pattern, then it is possible to reduce the number of observations. We discuss exact and approximate algorithms to solve the problem, and provide an experimental evaluation of them. We apply the resulting algorithms to verification of linear temporal logics formulæ. Finally, we discuss possible generalizations and extensions, and, in particular, how event detection can benefit from logic programming techniques.     

Post-processing and visualization techniques in 2D boundary element analysis

Most post-processors for boundary element (BE) analysis use an auxiliary domain mesh to display domain results, working against the profitable modelling process of a pure boundary discretization. This paper introduces a novel visualization technique which preserves the basic properties of the boundary element methods. The proposed algorithm does not require any domain discretization and is based on the direct and automatic identification of isolines. Another critical aspect of the visualization of domain results in BE analysis is the effort required to evaluate results in interior points. In order to tackle this issue, the present article also provides a comparison between the performance of two different BE formulations (conventional and hybrid). In addition, this paper presents an overview of the most common post-processing and visualization techniques in BE analysis, such as the classical algorithms of scan line and the interpolation over a domain discretization. The results presented herein show that the proposed algorithm offers a very high performance compared with other visualization procedures.     

A particular approach for the Three-dimensional Packing Problem with additional constraints

This paper focuses on a restrained concretization of the general NP-hard Container Loading Problem that arises from a real world application. This particular problem can be informally described as: given different sets of bins and boxes, find the packing of the boxes into the smallest number of bins obeying some additional restrictions on the placement. The mathematical programming formulation that appears to better model this application is the Three-dimensional Bin-Packing Problem (3D-BPP) which is no more than an extension of the classic Bin-Packing Problem to the orthogonal packing of solid objects.We present an alternative non-linear formulation for the 3D-BPP version as well as new designed heuristic algorithms (CPBOX and BOXCP) for the approximation of the optimal solution using boxes and bins of heterogeneous dimensions. Moreover, we also present a heuristic specifically designed to work under very particular storage application restrictions. The numerical results indicate that all of these new heuristics have good performance standards especially when applied to replications of real input data.     

Tree pattern mining with tree automata constraints

Most work on pattern mining focuses on simple data structures such as itemsets and sequences of itemsets. However, a lot of recent applications dealing with complex data like chemical compounds, protein structures, XML and Web log databases and social networks, require much more sophisticated data structures such as trees and graphs. In these contexts, interesting patterns involve not only frequent object values (labels) appearing in the graphs (or trees) but also frequent specific topologies found in these structures. Recently, several techniques for tree and graph mining have been proposed in the literature. In this paper, we focus on constraint-based tree pattern mining. We propose to use tree automata as a mechanism to specify user constraints over tree patterns. We present the algorithm CoBMiner which allows user constraints specified by a tree automata to be incorporated in the mining process. An extensive set of experiments executed over synthetic and real data (XML documents and Web usage logs) allows us to conclude that incorporating constraints during the mining process is far more effective than filtering the interesting patterns after the mining process.     

Control of absorption columns in the bioethanol process: Influence of measurement uncertainties

The alcohol lost by evaporation during the bioethanol fermentation process may be collected and recovered using an absorption column. This equipment is also used in the carbonic gas treatment, a by-product from the sugar cane fermentation. In the present work, the development of nonlinear feedforward–feedback controllers, based on neural network inverse models, was proposed and tested to manipulate the absorbent flow rates. The control purposes are: to keep low ethanol concentration in the effluent gas phase from the first absorption column (ethanol recovery column); and to reduce the residual water concentration in the CO₂ gas effluent from the second tower (CO₂ treatment column).Based on simulation studies, the neural network (ANN) controller performance was compared with the conventional PID control scheme application. The best ANN architecture was set up according to the Foresse and Hagan (1997) criterion, while the PID parameters were found from the well-known Cohen–Coon Equations and trial-and-error fine tuning.Initially, performances were evaluated for the system without concentration measurement uncertainties. From these tests, the ANN controller presented the smallest response time and overshoot for regulator and servo problems. Three uncertainty levels were applied afterwards: 5%, 10%, and 15%.The ANN controller outperformed the PID for all uncertainty levels tested for the ethanol recovery column. For the CO₂ treatment column, the ANN controller proceeded successfully under uncertainties of 5% and 10%, while the PID did not deal properly with uncertainties above 5%. The statistical F-test, besides the ITAE, ISE, and IAE performance criteria, were calculated for both controllers applications and then compared. They proved the superiority of the ANN control scheme.Using appropriately the proposed well-controlled absorption columns increases the efficiency of the bioethanol production plant and can also provide carbon credits by avoiding CO₂ emission into the atmosphere.