The ESA Rosetta spacecraft investigated comet 67P/Churyumov-Gerasimenko duringtwo years from August 2014 to the end of September 2016. The dual Langmuir probewas used to measure plasma parameters including the thermal energy of theelectrons. The observed thermal energy (or temperature) of the electrons was ratherhigh, in the range 5-10 eV almost throughout the mission. However, near perihelionthe Langmuir probe measurements indicated the prevalence of two electronpopulations with distinct temperatures, one hot (5-10 eV) and one cold (less than 1eV). It has been hypothesized that the electrons of the colder population wereformed relatively close to the nucleus and that they subsequently cooled by inelasticcollisions with the neutral gas. In this project work we develop a model for studyingelectron cooling in a cometary coma. The model takes into account collisions withwater molecules as well as the influence of a radial ambipolar electric field. / Rymdsonden Rosetta från ESA undersökte kometen 67P/Churyumov Gerasimenkounder mer än två år, från augusti 2014 till slutet av september 2016.En Langumirprob användes för att undersökta plasmamiljön runt kometen, tillexempel elektronernas termiska energi. Den observerade termiska energin förelektronerna (eller elektrontemperaturen) var ganska hög, ca 5-10 eV undernästan hela uppdraget, men när kometen var nära perihelium detekterade instrumentenäven kalla elektroner, med en energi under 1 eV, distinkta från devarma. En hypotes är att dessa kalla elektroner bildas nära kärnan av att varmaelektroner genomgår inelastiska kollisioner med den neutrala gasen och tapparsin energi. I detta projekt utvecklar vi en modell för att studera elektronernasbeteende i koman. Modellen tar hänsyn till kollisioner med neutrala vattenmolekylersåväl som påverkan av ett radiellt ambipolärt elektriskt fält.

Objectives: Intracranial subdural empyema (ICSDE) can be a devastating condition, with a sequelae ranging from epilepsy, focal deficits to death. Factors affecting the outcome in subdural empyema range from level of consciousness, the extend of subdural pus at the time of diagnosis and the type of surgical procedure performed. Previous studies have conflicting results of unfavourable prognostic factors associated with ICSDE. The outcome of this condition at Steve Biko Academic Hospital (SBAH) is reported, as well as factors influencing the outcome. Methods: A retrospective analysis of all the patients admitted at neurosurgery unit of SBAH during 2006 – 2010 period with confirmed subdural empyema on brain CT scan and at surgery. Data sheet was used to collect all clinical information from patients’ records. Glasgow Outcome Scale and Henk W. Mauser grading were used to report on the outcome. Results: A total of 34 patients (20 males and 14 females) with mean age of 16.1 years were admitted with a diagnosis of ICSDE. The common presenting features were headache (58.8%), fever and seizures (47.0% each). Over 61% of patients had hemiplegia at presentation. CT scan confirmed subdural collections with 70.6% over the convexity, 23.5% at the convexity and parafalx and only 5.9% had bilateral collections. Complicated paranasal sinusitis was the origin of infection in 82.3%, followed by meningitis with 8.8%. Burr hole washout was done in 52.9% of patients, while 38.2% had burr holes with drains in situ and 8.8% had craniotomy to evacuate the subdural pus. All the patients were given empiric triple antibiotic therapy. Streptococci species were the most cultured organisms in the 19 (56.0%) patients who had positive cultures, however 15 (44.0%) patients had negative cultures. Resistance to penicillin was noted in 5.0% of cases only. Sixty-five percent of patients had good outcome with no seizures nor neurological deficits. The overall mortality was 15.0% in this study, with none from patients who had craniotomy. Conclusion: Clinical presenting features and organisms cultured seems to be the same internationally, particularly those due to complicated sinusitis. Empiric triple antibiotic therapy of 3rd generation cephalosporin plus vancomycin plus metronidazole is still relevant at SBAH. Factors associated with favourable outcome were ages between 11 and 20 years, and craniotomy as the surgical procedure of choice. / Dissertation (MMEd)--University of Pretoria, 2013. / Neurology / Unrestricted

La aritmética en coma fija tiene la propiedad de realizar operaciones con números decimales con un coste computacional entero. A pesar de no estar soportada de forma nativa por los lenguajes de programación y por las CPUs generalistas, es la aritmética ideal para aplicaciones de control industrial, simulación, informática gráfica, multimedia y señal digital, etc. Su falta de normalización y soporte impide su uso extendido en muchos campos de la informática. Esta tesis justifica la utilización de esta aritmética en el campo de los gráficos por computador. A partir de un estudio de implementación y normalización de la aritmética, se estudian incrementos de potencia relativos y precisiones obtenidas y su aplicación a la simulación discreta y de vuelo. Se analizan los algoritmos de dibujo de primitivas básicas como las líneas, con y sin aliasing, su recortado y el dibujo de circunferencias y elipses. Se presentan algunas implementaciones de algoritmos basados en la coma fija y se analiza la mejora del coste computacional y de la precisión obtenida respecto de los algoritmos de fuerza bruta y de los tradicionales. Mientras los algoritmos tradicionales suelen entregar un error comprendido entre los 0.32 y 0.45 píxeles, dependiendo de la primitiva analizada, los algoritmos basados en la coma fija no superan los 0.25 de media, igualando el error teórico generado por los algoritmos de fuerza bruta. Por otro lado, los algoritmos basados en la aritmética en coma fija suelen mejorar la velocidad media de los algoritmos tradicionales, pudiéndose a veces conseguir aceleraciones elevadas si se utilizan técnicas de paralelización. Éste sería el caso de la versión paralela del algoritmo DDA con y sin antialiasing que podría dibujar una recta con coste temporal logarítmico respecto de su longitud en píxeles. Los algoritmos obtenidos son tan sencillos que pueden ser implementados algunos de ellos en hardware dentro de un procesador gráfico de forma muy eficiente. / Mollá Vayá, RP. (2001). Aplicaciones de la aritmética en coma fija a la representación de primitivas gráficas de bajo nivel [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/15406 / Palancia

Nurses, especially those who care for the critically ill, are required to perform high-level intensive clinical care. It is common for complicated procedures such as therapeutic hypothermia (TH) to be done infrequently at small community hospitals. According to the 2020 recommendations by the American Heart Association (AHA), “prompt initiation of targeted temperature management (formally known as TH) is necessary for all patients who do not follow commands after return of spontaneous circulation to ensure optimal functional and neurological outcome” (Panchal et al., 2020, p.S366). These high-risk, low-frequency protocols typically require nurses to be able to perform these procedures in a time-sensitive manner. If the procedures are not done correctly, they can have negative patient outcomes. Patients are put into medically induced comas, maintained on ventilators, cooled to very low body temperatures, and often medically paralyzed to inhibit shivering. Each of these conditions has the potential for adverse outcomes and together can lead to poor neurological outcomes and even death (Kim et al., 2015). Health educators have the opportunity to provide knowledge and support to these nurses as a way to improve patient outcomes. In this study, a patient care checklist and an online self-learning module were developed for nurses to learn how to perform this high-risk procedure quickly and effectively. A focus group was then conducted with a group of nurses to gain feedback on the checklist and module, and these data informed specific changes to these materials. Then, drawing on a sample of 60 nurses and using a post-study design, data were collected to determine the effectiveness of the checklist and online module as compared to a control group of nurses who read a scholarly article on the same subject. Data were collected at two time points for both the experimental and control groups. The results indicated that nurses who used the online learning tool scored higher in the post-assessment than those in the control group (t = 6.092, p < .001, BCondition = 3.865), with a remarkably high effect size, r2 = 0.379. Moreover, 77% of the nurses agreed that protocols and checklists helped nurses minimize disparities in patient health outcomes. Additionally, 95% of the nurses agreed that patient care checklists helped them care for patients when delivering high-risk, low-volume protocols such as TH. This study demonstrated that online learning tools provide an effective way to educate nurses, and checklists and protocols support the implementation of high-risk, low-volume procedures such as TH.

Datenbanken finden in mehr und mehr Bereichen einen Einsatz. Angestrebter Datenaustausch zur Vernetzung von Informationen und Gewinnung zusätzlicher Kenntnisse ist wegen der Heterogenität von den Datenbanken problembehaftet. Schema- Matching beinhaltet durch das Erzeugen von Korrespondenzen zwischen Schemata eine Lösungsmöglichkeit für zumindestens einen Teil dieser Probleme. Viele Ansätze wurden schon für das Schema-Matching entwickelt und werden in dieser Arbeit dargestellt. Es werden Strategien zur Wiederverwendung näher erläutert und Erweiterungen für die Mapping-Wiederverwendung vorgestellt. Die neuen Strategien, die in dieser Diplomarbeit entstehen, wurden in dem Schema-Matching-Prototyp COMA++ integriert und zusammen mit anderen Strategien evaluiert.

In der vorliegenden Masterarbeit wird erläutert, wie ein klassischer Schema Matcher erweitert wird, um Komplexe Korrespondenzen (many-to-many-Korrespondenzen) und allgemeine Funktionen zwischen zwei Schemata auszudrücken, sowie deren automatische Entdeckung als Erweiterung der herkömmlichen Entdeckung von (1:1)-Korrespondenzen. Der letzte Punkt widmet sich dabei einem Gebiet der Datenintegration, das bisher kaum untersucht wurde, und es werden Ansätze vorgestellt, die für viele Schema Matcher eine Bereicherung darstellen können. Zu diesem Zweckwerden im ersten Teil der Arbeit Komplexe Korrespondenzen und Funktionen im Bereich des Schema Mappings ausführlich vorgestellt.

Despite the consensus that glutamatergic and GABAergic imbalance is likely to be involved in anesthesia or coma, there is little known about molecular mechanisms of action of gaseous anesthetics. The target article by Smythies (1999) is engagingly analytical and insightful, proposing novel and testable hypotheses for the molecular mechanisms of action of anesthetics as well as for processes that may be involved in coma. The most creative and convincing of his hypotheses concerns the crucial role of iron in maintaining neural respiration and energy production as well as its involvement in synaptic plasticity. Smythies' paper is certain to stimulate new ideas and experiments on the molecular mechanisms of anesthesia and coma.

Myxedema coma and pituitary apoplexy are well-known life-threatening endocrine emergencies. The coincidence of these entities is exceedingly rare. Myxedema coma occurring as a result of pituitary lesion is a much less seen entity. A high index of suspicion is often required for early diagnosis as it is of particular importance in improving survival outcomes. We present a rare case of a patient with myxedema coma presenting as bradycardia and hypotension secondary to pituitary apoplexy, which was confirmed on magnetic resonance imaging (MRI). The patient was managed conservatively with levothyroxine and stress doses of steroid, with the resolution of hemodynamic changes and a decrease in the size of the suprasellar mass.

Dans le milieu clinique des soins intensifs, l’induction du coma médicamenteux (i.e. iatrogénique) par les sédatifs et les analgésiques est souvent associée à une augmentation significative du délirium. De plus, l’utilisation de sédatifs et d’analgésiques comme le fentanyl et le midazolam sans interruption et sans ajustement aux besoins du patient augmentent la durée de séjour, les coûts et la mortalité. Le but de cette étude était d’explorer les facteurs de variabilité pouvant influencer la survenue du coma iatrogénique et du délirium tel que : les facteurs génétiques/sociodémographiques et la co-administration de médicaments substrats ou inhibiteurs de CYP3A4/3A5 ou de la glycoproteine P. L’étude prospective à visée observationnelle a été effectuée à l’unité de soins intensifs de l’hôpital Maisonneuve-Rosemont avec 53 patients perfusés avec fentanyl ou midazolam. La faisabilité du modèle pharmacocinétique du fentanyl a été mise en évidence à partir des échantillons sanguins des patients et était compatible avec les données cliniques. Cette étude montre donc que contrairement au profil génomique de CYP3A5 (p value = 0,521) et MDR1 (p value = 0,828), les effets des interactions médicamenteuses entre les inhibiteurs CYP3A4/CYP3A5 et fentanyl/midazolam représentent un facteur de risque pour le coma iatrogénique (p value = 0,014). Ces effets peuvent être facilement identifiés et sont prévisibles; résultats qui seront utiles aux praticiens – intensivistes dans le choix d’une thérapie pharmacologique appropriée pour prévenir les complications morbides comme le coma iatrogénique et le délirium. / When sedatives such as midazolam or opiate analgesics such as fentanyl administered to critically ill patients and medication-induced coma occurs, increased delirium is observed. In addition, there is an increase in the length of stay in ICU, in costs and mortality. The purpose of this study was to explore the factors of variability affecting the incidence of iatrogenic coma and delirium: genetics/socio demographics factors, co-administration of substrates/inhibitors of CYP3A4/3A5 or P-gp. We performed a prospective cohort observational study of 53 hospitalized patients treated with fentanyl or/and midazolam in the intensive care unit of the Maisonneuve-Rosemont hospital The feasibility of pharmacokinetics modeling using blood samples from critically ill patients was demonstrated and was compatible with clinical data. This study suggests that contrary to genomic variants in the CYP3A5 (p value = 0,521) and MDR1 (p value = 0,828) genes, the effect of drugs and drugs interactions between inhibitors of CYP3A4/3A5 and fentanyl/ midazolam constitutes the main risk factor for iatrogenic coma (p value - 0,014). These effects are easily identifiable and predictable, and are very important for intensive care workers to make the appropriate choice of medication in order to prevent morbid complications such as iatrogenic coma and delirium.

Coma, estado vegetativo e sedação são desordens da consciência com diferenças clínicas em que ocorrem redução generalizada ou alteração no conteúdo da consciência, somadas a deficiências no despertar. Objetivo: analisar as relações entre as respostas vitais, faciais e de tônus muscular frente ao estímulo música ou mensagem em pacientes em coma, estado vegetativo ou sedado. Método: Ensaio Clínico Controlado Transversal Unicego para o pesquisador. Local da coleta: duas Unidades de Terapia Intensiva e uma Enfermaria de um Hospital Público de Ensino e Pesquisa. Procedimento de coleta de dados: pacientes com Escala Coma de Glasgow entre 3 e 8 ou Escala de Sedação de Ramsay de 5 ou 6 foram alocados aleatoriamente em um dos três grupos (experimental música, experimental mensagem ou controle). Os familiares gravaram uma mensagem de voz e escolheram uma música de acordo com a preferência do paciente. Foram coletados os sinais vitais, eletroneurografia e expressão facial dos pacientes nos períodos basal e durante a intervenção. Duas sessões de intervenção foram realizadas no mesmo dia. Após 30-40 dias da intervenção inicial foi aplicada a Escala de Resultado de Glasgow. Resultados: a maioria dos 76 pacientes em coma, 9 estado vegetativo ou sedados eram do sexo masculino, tinham entre 18 e 36 anos e foram internados por trauma. Encontrou-se alterações estatisticamente significantes nas variáveis temperatura, expressão facial, eletroneurografia e Escala de Resultado de Glasgow nas análises realizadas nesse estudo, além de alterações mais freqüentes na sessão 2, nos pacientes em coma e estado vegetativo, no canal 1 da eletroneurografia (músculo frontal) e no grupo experimental mensagem com valores médios e porcentagem maiores do que no grupo experimental música. Conclusões: Os resultados em relação aos sinais vitais são limitados e inconclusivos, o que dificulta qualquer inferência em relação a sua influência nas respostas dos pacientes com desordens de consciência em relação aos estímulos apresentados. A expressão facial e a eletroneurografia parecem ser variáveis mais confiáveis para avaliação das respostas desses pacientes, no entanto, mais estudos são sugeridos. / Coma, vegetative state and sedation are disorders of consciousness with clinical differences where a generalized reduction or alteration occurs in the consciousness content, coupled with deficiencies in waking. Objective: to analyze the relations between the vital signs, facial expressions and muscular tonus to the music or message stimuli in coma, vegetative state or sedated patients. Method: This study was a single-blinded transversal controlled clinical trial. Data collection: two Intensive Care Units and one ward of a Public Hospital of Education and Research. Procedure: patients with Glasgow Coma Scale between 3 and 8 or Ramsay Sedation Scale of 5 or 6 being randomly placed into one of the three groups (experimental music, experimental message or control). Their relatives recorded a voice message and chose a song according to the patients preference. The vital signs, eletroneurography and facial expressions of the patients were collected both in the baseline and also during the intervention. Two intervention sessions were performed on the same day. The Glasgow Outcome Scale was applied 30-40 days after the initial intervention. Results: the majority of the 76 coma, vegetative state or 11 sedated patients were masculine, between the ages of 18 and 36 and had been interned for trauma. Statistically significant alterations were noted in the variables of temperature, facial expression, eletroneurography and Glasgow Outcome Scale in the analyses performed in this study, in addition to more frequent alterations in session 2, in the coma and vegetative state patients, in channel 1 of the eletroneurography (frontal muscle) and in the message experimental group with mean values and higher percentages than in the music experimental group. Conclusions: The results, in relation to the vital signs, are limited and inconclusive, which complicates any inference regarding their influence on the responses of patients with disorders of consciousness in relation to stimuli. Facial expressions and eletroneurography, seem to be the more reliable variables for evaluation of the responses of these patients; however, additional studies are suggested.