Hemodynamics and outcome of septic shock

Septic shock is a common killer in intensive care units (ICU). The most crucial issue concerning the outcome is the early and aggressive start of treatment aimed at normalization of hemodynamics and the early start of antibiotics during the very first hours. The optimal targets of hemodynamic treatment, or impact of hemodynamic treatment on survival after first resuscitation period are less known. The objective of this study was to evaluate different aspects of the hemodynamic pattern in septic shock with special attention to prediction of outcome. In particular components of early treatment and monitoring in the ICU were assessed. A total of 401 patients, 218 with septic shock and 192 with severe sepsis or septic shock were included in the study. The patients were treated in 24 Finnish ICUs during 1999-2005. 295 of the patients were included in the Finnish national epidemiologic Finnsepsis study. We found that the most important hemodynamic variables concerning the outcome were the mean arterial pressures (MAP) and lactate during the first six hours in ICU and the MAP and mixed venous oxygen saturation (SvO2) under 70% during first 48 hours. The MAP levels under 65 mmHg and SvO2 below 70% were the best predictive thresholds. Also the high central venous pressure (CVP) correlated to adverse outcome. We assessed the correlation and agreement of SvO2 and mean central venous oxygen saturation (ScvO2) in septic shock during first day in ICU. The mean SvO2 was below ScvO2 during early sepsis. Bias of difference was 4.2% (95% limits of agreement 8.1% to 16.5%) by Bland-Altman analysis. The difference between saturation values correlated significantly to cardiac index and oxygen delivery. Thus, the ScvO2 can not be used as a substitute of SvO2 in hemodynamic monitoring in ICU. Several biomarkers have been investigated for their ability to help in diagnosis or outcome prediction in sepsis. We assessed the predictive value of N-terminal pro brain natriuretic peptide (NT-proBNP) on mortality in severe sepsis or septic shock. The NT-proBNP levels were significantly higher in hospital nonsurvivors. The NT-proBNP 72 hrs after inclusion was independent predictor of hospital mortality. The acute cardiac load contributed to NTproBNP values at admission, but renal failure was the main confounding factor later. The accuracy of NT-proBNP, however, was not sufficient for clinical decision-making concerning the outcome prediction. The delays in start of treatment are associated to poorer prognosis in sepsis. We assessed how the early treatment guidelines were adopted, and what was the impact of early treatment on mortality in septic shock in Finland. We found that the early treatment was not optimal in Finnish hospitals and this reflected to mortality. A delayed initiation of antimicrobial agents was especially associated with unfavorable outcome.

Language Influence in Services: Perceived Importance of Native Language Use in Service Encounters

A defining characteristic of most service encounters is that they are strongly influenced by interactions in which both the consumer and the service personnel are playing integral roles. Such is the importance of this interaction that it has even been argued that for the consumer, these encounters are in fact the service. Given this, it is not surprising that interactions involving communication and customer participation in the service encounters have received considerable attention within the field of services marketing. Much of the research on interactions and communication in services, however, appear to have assumed that the consumer and the service personnel by definition are perfectly able to interact and communicate effortlessly with each other. Such communication would require a common language, and in order to be able to take this for granted the market would need to be fairly homogenous. The homogenous country, however, and with it the homogenous market, would appear to be gone. It is estimated that more than half the consumers in the world are already speaking more than one language. For a company entering a new market, language can be a major barrier that firms may underestimate, and understanding language influence across different markets is important for international companies. The service literature has taken a common language between companies and consumers for granted but this is not matched by the realities on the ground in many markets. Owing to the communicational and interaction-oriented nature of services, the lack of a common language between the consumer and the service provider is a situation that could cause problems. A gap exists in the service theory, consisting of a lack of knowledge concerning how language influences consumers in service encounters. By addressing this gap, the thesis contributes to an increased understanding of service theory and provides a better practical understanding for service companies of the importance of native language use for consumers. The thesis consists of four essays. Essay one is conceptual and addresses how sociolinguistic research can be beneficial for understanding consumer language preferences. Essay two empirically shows how the influence of language varies depending on the nature of the service, essay three shows that there is a significant difference in language preferences between female and male consumers while essay four empirically compares consumer language preferences in Canada and Finland, finding strong similarities but also indications of difference in the motives for preferring native language use. The introduction of the thesis outlines the existence of a research gap within the service literature, a gap consisting of the lack of research into how native language use may influence consumers in service encounters. In addition, it is described why this gap is of importance to services and why its importance is growing. Building on this situation, the purpose of the thesis is to establish the existence of language influence in service encounters and to extend the knowledge of how language influences consumers on multilingual markets.

Elimination of cross-talk in diffuse optical tomographic reconstructions through a weighted update procedure: results of simulation study - art. no. 61640S

Reconstructions in optical tomography involve obtaining the images of absorption and reduced scattering coefficients. The integrated intensity data has greater sensitivity to absorption coefficient variations than scattering coefficient. However, the sensitivity of intensity data to scattering coefficient is not zero. We considered an object with two inhomogeneities (one in absorption and the other in scattering coefficient). The standard iterative reconstruction techniques produced results, which were plagued by cross talk, i.e., the absorption coefficient reconstruction has a false positive corresponding to the location of scattering inhomogeneity, and vice-versa. We present a method to remove cross talk in the reconstruction, by generating a weight matrix and weighting the update vector during the iteration. The weight matrix is created by the following method: we first perform a simple backprojection of the difference between the experimental and corresponding homogeneous intensity data. The built up image has greater weightage towards absorption inhomogeneity than the scattering inhomogeneity and its appropriate inverse is weighted towards the scattering inhomogeneity. These two weight matrices are used as multiplication factors in the update vectors, normalized backprojected image of difference intensity for absorption inhomogeneity and the inverse of the above for the scattering inhomogeneity, during the image reconstruction procedure. We demonstrate through numerical simulations, that cross-talk is fully eliminated through this modified reconstruction procedure.

Conditionally One of 'Us' : A Study of Print Media, Minorities and Positioning Practices

This study deals with how ethnic minorities and immigrants are portrayed in the Finnish print media. The study also asks how media users of various ethnocultural backgrounds make sense of these mediated stories. A more general objective is to elucidate negotiations of belonging and positioning practices in an increasingly complex society. The empirical part of the study is based on content analysis and qualitative close reading of 1,782 articles in five newspapers (Hufvudstadsbladet, Vasabladet, Helsingin Sanomat, Iltalehti and Ilta-Sanomat) during various research periods between 1999 and 2007. Four case studies on print media content are followed up by a focus group study involving 33 newspaper readers of Bosnian, Somalian, Russian, and 'native' Finnish backgrounds. The study draws from different academic and intellectual traditions; mainly media and communication studies, sociology and social psychology. The main theoretical framework employed is positioning theory, as developed by Rom Harré and others. Building on this perspective, situational self-positioning, positioning by others, and media positioning are seen as central practices in the negotiation of belonging. In support of contemporary developments in social sciences, some of these negotiations are seen as occurring in a network type of communicative space. In this space, the media form one of the most powerful institutions in constructing, distributing and legitimising values and ideas of who belongs to 'us', and who does not. The notion of positioning always involves an exclusionary potential. This thesis joins scholars who assert that in order to understand inclusionary and exclusionary mechanisms, the theoretical starting point must be a recognition of a decent and non-humiliating society. When key insights are distilled from the five empirical cases and related to the main theories, one of the major arguments put forward is that the media were first and foremost concerned with a minority actor's rightful or unlawful belonging to the Finnish welfare system. However, in some cases persistent stereotypes concerning some immigrant groups' motivation to work, pay taxes and therefore contribute are so strong that a general idea of individualism is forgotten in favour of racialised and stagnated views. Discussants of immigrant background also claim that the positions provided for minority actors in the media are not easy to identify with; categories are too narrow, journalists are biased, the reporting is simplifying and carries labelling potential. Hence, although the will for the communicative space to be more diverse and inclusive exists — and has also in many cases been articulated in charters, acts and codes — the positioning of ethnic minorities and immigrants differs significantly from the ideal.

The Biopolitics of Gender

This dissertation inquires into the relationship between gender and biopolitics. Biopolitics, according to Michel Foucault, is the mode of politics that is situated and exercised at the level of life. The dissertation claims that gender is a technology of biopower specific to the optimisation of the sexual reproduction of human life, deployed through the scientific and governmental problematisation of declining fertility rates in the mid-twentieth century. Just as Michel Foucault claimed that sexuality became a scientific and political discourse in the nineteenth century, gender has also since emerged in these fields. In this dissertation, gender is treated as neither a representation of sex nor a cultural construct or category of identity. Rather, a genealogy of gender as an apparatus of biopower in conducted. It demonstrates how scientific and theoretical developments in the twentieth century marshalled gender into the sex/sexuality apparatus as a new technology of liberal biopower. Gender, I argue, has become necessary for the Western liberal order to recapture and re-optimise the life-producing functions of sex that reproduce the very object of biopolitics: life. The concept of the life function is introduced to analyse the life-producing violence of the sex/sexuality/gender apparatus. To do this, the thesis rereads the work of Michel Foucault through Gilles Deleuze for a deeper grasp of the material strategies of biopower and how it produces categories of difference and divides population according to them. The work of Judith Butler, in turn, is used as a foil against which to rearticulate the question of how to examine gender genealogically and biopolitically. The dissertation then executes a genealogy of gender, tracing the changing rationalities of sex/sexuality/gender from early feminist thought, through mid-twentieth century sexological, feminist, and demographic research, to current EU policy. According to this genealogy, in the mid-twentieth century demographers perceived that sexuality/sex, which Foucault observed as the life-producing biopolitical apparatus, was no longer sufficiently disciplining human bodies to reproduce. The life function was escaping the grasp of biopower. The analysis demonstrates how gender theory was taken up as a means of reterritorialising the life function: nature would be disciplined to reproduce by controlling culture. The crucial theoretical and genealogical argument of the thesis, that gender is a discourse with biopolitical foundations and a technology of biopower, radically challenges the premises of gender theory and feminist politics, as well as the emancipatory potential often granted to the gender concept. The project asks what gender means, what biopolitical function it performs, and what is at stake for feminist politics when it engages with it. In so doing, it identifies biopolitics and the problem of life as possibly the most urgent arena for feminist politics today.

Identification of Local Conformational Similarity in Structurally Variable Regions of Homologous Proteins Using Protein Blocks

Structure comparison tools can be used to align related protein structures to identify structurally conserved and variable regions and to infer functional and evolutionary relationships. While the conserved regions often superimpose well, the variable regions appear non superimposable. Differences in homologous protein structures are thought to be due to evolutionary plasticity to accommodate diverged sequences during evolution. One of the kinds of differences between 3-D structures of homologous proteins is rigid body displacement. A glaring example is not well superimposed equivalent regions of homologous proteins corresponding to a-helical conformation with different spatial orientations. In a rigid body superimposition, these regions would appear variable although they may contain local similarity. Also, due to high spatial deviation in the variable region, one-to-one correspondence at the residue level cannot be determined accurately. Another kind of difference is conformational variability and the most common example is topologically equivalent loops of two homologues but with different conformations. In the current study, we present a refined view of the ``structurally variable'' regions which may contain local similarity obscured in global alignment of homologous protein structures. As structural alphabet is able to describe local structures of proteins precisely through Protein Blocks approach, conformational similarity has been identified in a substantial number of `variable' regions in a large data set of protein structural alignments; optimal residue-residue equivalences could be achieved on the basis of Protein Blocks which led to improved local alignments. Also, through an example, we have demonstrated how the additional information on local backbone structures through protein blocks can aid in comparative modeling of a loop region. In addition, understanding on sequence-structure relationships can be enhanced through our approach. This has been illustrated through examples where the equivalent regions in homologous protein structures share sequence similarity to varied extent but do not preserve local structure.

A Comparative Study of Electrical Switching Behavior of Certain Tellurium based Chalcogenide Thin Films for Phase Change Memory (PCM) Applications

This work describes the electrical switching behavior of three telluride based amorphous chalcogenide thin film samples, Al-Te, Ge-Se-Te and Ge-Te-Si. These amorphous thin films are made using bulk glassy ingots, prepared by conventional melt quenching technique, using flash evaporation technique; while Al-Te sample has been coated in coplanar electrode geometry, Ge-Se-Te and Ge-Te-Si samples have been deposited with sandwich electrodes. It is observed that all the three samples studied, exhibit memory switching behavior in thin film form, with Ge-Te-Si sample exhibiting a faster switching characteristic. The difference seen in the switching voltages of the three samples studied has been understood on the basis of difference in device geometry and thickness. Scanning electron microscopic image of switched region of a representative Ge15Te81Si4 sample shows a structural change and formation of crystallites in the electrode region, which is responsible for making a conducting channel between the two electrodes during switching.

Influence of growth ambience and doping on the structural properties of multiferroic DyMnO3

We report on the single crystal growth of 50% Sr and Y doped multiferroic DyMnO3 using optical floating zone technique. A comparison of the effect of growth ambience and of chemical substitution on the crystal structure of DyMnO3 is attempted. It is observed that DyMnO3 adopts Pm3m cubic structure with 50% Sr doping whereas with 50% Y doping, the crystal structure is hexagonal P6(3)cm. Orthorhombic Pnma structure is adopted by DyMnO3 when grown in air, whereas hexagonal P6(3)cm structure is obtained when grown under the ambience of argon. The structural polymorphism is discussed in terms of difference in ionic sizes of Sr, Y and Dy, comparable Gibbs free energies and coordination schemes of surrounding oxygens for hexagonal and orthorhombic structures of DyMnO3. (C) 2012 Elsevier B.V. All rights reserved.

In vitro osteogenic cell proliferation, mineralization, and in vivo osseointegration of injection molded high-density polyethylene-based hybrid composites in rabbit animal model

The present work reports the biocompatibility property of injection molded HDPE-HA-Al2O3 hybrid composites. In vitro cytocompatibility results reveal that osteogenic cell viability and bone mineralization are favorably supported in a statistically significant manner on HDPE-20% HA-20% Al2O3 composite, in comparison to HDPE-40 wt.% HA or HDPE-40 wt.% Al2O3. The difference in cytocompatibility property is explained in terms of difference in substrate wettability/surface energy and importantly, both the cell proliferation at 7 days or bone mineralization at 21 days on HDPE-20% HA-20% Al2O3 composite are either comparable or better than sintered HA. The progressive healing of cylindrical femoral bone defects in rabbit animal model was assessed by implantation experiments over 1, 4 and 12 weeks. Based on the histological analysis as well as histomorphometrical evaluation, a better efficacy of HDPE-20% HA-20% Al2O3 over high-density polyethylene (HDPE) for bone regeneration and neobone formation at host bone-implant interface was established. Taken together, the present study unequivocally establishes that despite the presence of 20% Al2O3, HDPE-based hybrid composites are as biocompatible as HA in vitro or better than HDPE in vivo.

Difference schemes on non-uniform mesh and their application

High order accurate schemes are needed to simulate the multi-scale complex flow fields to get fine structures in simulation of the complex flows with large gradient of fluid parameters near the wall, and schemes on non-uniform mesh are desirable for many CFD (computational fluid dynamics) workers. The construction methods of difference approximations and several difference approximations on non-uniform mesh are presented. The accuracy of the methods and the influence of stretch ratio of the neighbor mesh increment on accuracy are discussed. Some comments on these methods are given, and comparison of the accuracy of the results obtained by schemes based on both non-uniform mesh and coordinate transformation is made, and some numerical examples with non-uniform mesh are presented.

Design of an optimised wheel profile for rail vehicles operating on two track gauges

This paper sets out an optimum synthesis methodology for wheel profiles of railway vehicles in order to secure good dynamic behaviour with different track configurations. Specifically, the optimisation process has been applied to the case of rail wheelsets mounted on double gauge bogies, that move over two different gauges, which also have different types of rail: the Iberian gauge (1668 mm) and the UIC gauge (1435 mm). Optimisation is performed using Genetic Algorithms and traditional optimisation methods in a complementary way. The objective function used is based on an ideal equivalent conicity curve which ensures good stability on straight sections and also proper negotiation of curves. To this end the curve is constructed in such a way that it is constant with a low value for small lateral wheelset displacements (with regard to stability), and increases as the displacements increase (to facilitate negotiation of curved sections). Using this kind of ideal conicity curve also enables a wheel profile to be secured where the contact points have a larger distribution over the active contact areas, making wear more homogeneous and reducing stresses. The result is a wheel profile with a conicity that is closer to the target conicity for both gauges studied, producing better curve negotiation while maintaining good stability on straight sections of track. The paper shows the resultant wheel profile, the contact curves it produces, and a number of dynamic analyses demonstrating better dynamic behaviour of the synthesised wheel on curved sections with respect to the original wheel.

Additions to a revision of the shark genus Carcharhinus: Synonymy of Aprionodon and Hypoprion, and description of a new species of Carcharhinus (Carcharhinidae)

Features of the valid nominal species of Aprionodon Gill (isodon Valenciennes) and Hypoprion Muller and Henle (hemiodon Valenciennes, macloti Muller and Henle, and signatus Poey), plus those of a previously unrecognized species here described as Carcharhinus leiodon n.sp., are examined and compared with those of Carcharhinus Blainville. Features studied include morphometrics, vertebral numbers and other vertebral characteristics, tooth numbers, color pattern, and some other aspects of external morphology. It is concluded that on these features C. leiodon n.sp. is entirely encompassed within the parameters of Carcharhinus, and that, although A. isodon, H. hemiodon, H. macloti, and H. signatus each extend the range of diversity of Carcharhinus in one or more features, A. isodon is not uniquely different from Carcharhinus, and there is no common pattern of difference between the three species of Hypoprion and Carcharhinus. Accordingly, and because the nature of the teeth of Aprionodon and Hypoprion has been found insufficient to warrant generic distinction from Carcharhinus, the genera Aprionodon and Hypoprion are synonymised with Carcharhinus. A diagnosis and description are given for each of the above species. The descriptions include measurements, counts, and line illustrations that show the whole shark in lateral view, underside of head, nostril, and teeth. The geographic distribution is summarized, as are also the meager biological data available on number of embryos, size at birth, size at sexual maturity, and maximum size. (PDF file contains 32 pages.)

Keep an "eye" on the text: The Use of Self-mention in the Academic Writing of Experts

One of the most controversial inquiries in academic writing is whether it is admissible to use first person pronouns in a scientific paper or not. Many professors discourage their students from using them, rather favoring a more passive tone, and thus causing novices to avoid inserting themselves into their texts in an expert-like manner. Abundant research, however, has recently attested that negotiation of identity is plausible in academic prose, and there is no need for a paper to be void of an authorial identity. Because in the course of the English Studies Degree we have received opposing prompts in the use of I, the aim of this dissertation is to throw some light upon this vexed issue. To this end, I compiled a corpus of 16 Research Articles (RAs) that comprises two sub-corpora, one featuring Linguistics RAs and the other one Literature RAs, and each, in turn, consists of articles written by American and British authors. I then searched for real occurrences of I, me, my, mine, we, us, our and ours, and studied their frequency, rhetorical functions and distribution along each paper. The results obtained certainly show that academic writing is no longer the faceless prose that it used to be, for I is highly used in both disciplines and varieties of English. Concerning functions, the most typically used roles were the use of I to take credit for the writer’s research process, and also those involving plural forms. With respect to the spatial disposition, all sections welcomed first person pronouns, but the Method and the Results/Discussion sections seem to stimulate their appearance. On the basis of these findings, I suggest that an L2 writing pedagogy that is mindful not only of the language proficiency, but also of the students’ own identity may have a beneficial effect on the composition of their texts.

Cores e com-posições de um Jardim de Infância Waldorf: tecendo com a Teoria Ator-rede

A presente pesquisa foi produzida num Jardim de Infância Waldorf no Rio de Janeiro e se propôs a um exercício de tradução, com o uso do dispositivo TeAR, que aliava o trabalho etnográfico no cotidiano escolar, aos elementos da tecelagem como artesania e ao modo de pesquisar da Teoria Ator-Rede (TAR). Entre as questões que emergiram ao longo do processo, podemos destacar: a com-vivência como prática educativa no encontro com a diferença, que vinculou-se ao método de PesquisarCOM da TAR, proposto pela psicóloga Marcia Moraes; uma maneira de aprender com os mal-entendidos, refazendo nossa maneira de interpelar o outro quando este recalcitra; incluindo humanos e não-humanos, sem domínios ou separações hierarquizantes; conhecendo com e não sobre o outro. Por outro lado, ao entendermos o conhecimento como processo de criação de si e do mundo, a produção de conhecimento na com-vivência fez emergir, como efeito das práticas de limite e recalcitrância, a diferenciação e singularização dos agentes, possibilitando a criação de novos limites e invenções. Assim, na afetação da experiência, chegamos à negociação dos interesses singulares e coletivos, na qual planos comuns e heterogêneos foram-se tecendo, de modo que as múltiplas possibilidades de vínculos aumentavam a potência de agir. Pensar com Latour que quando estamos mais vinculados, somos mais livres nos convida a experimentar novas formas de viver coletivamente, inventando a si de maneira vinculada e ao mesmo tempo proliferando modos de existir. Durante essa pesquisa, fiamos com as práticas do campo e tecemos versões de Educação Infantil na Pedagogia Waldorf cujos vínculos estão em movimento, constituindo uma ética na com-vivência

Sampling of frozen prawns for bacteriological estimation

Experiments were conducted to study the significance of difference between samples taken from the surface and interior of a frozen shrimps block, as well as to determine the size of sample necessary to represent the whole block, with respect to bacterial count determination. The results showed that the surface samples and interior samples did not differ significantly at 5% level of significance and that the minimum quantity representative of the block was 21-26 gms in the case of a block weighing about 1300 gms. The procedure adopted for taking the bacterial count was the normal standard plate count method.