916 resultados para The Performance Standard 6 –PS 6-
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Vol. 26, Issue 81, 8 pages
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A number of studies have shown that Fourier transform infrared spectroscopy (FTIR) can be applied to quantitatively assess lacustrine sediment constituents. In this study, we developed calibration models based on FTIR for the quantitative determination of biogenic silica (BSi; n = 420; gradient: 0.9-56.5%), total organic carbon (TOC; n = 309; gradient: 0-2.9%), and total inorganic carbon (TIC; n= 152; gradient: 0-0.4%) in a 318 m-long sediment record with a basal age of 3.6 million years from Lake El'gygytgyn, Far East Russian Arctic. The developed partial least squares (PLS) regression models yield high cross-validated (CV) R2CV = 0.86-0.91 and low root mean square error of cross-validation (RMSECV) (3.1-7.0% of the gradient for the different properties). By applying these models to 6771 samples from the entire sediment record, we obtained detailed insight into bioproductivity variations in Lake El'gygytgyn throughout the middle to late Pliocene and Quaternary. High accumulation rates of BSi indicate a productivity maximum during the middle Pliocene (3.6-3.3 Ma), followed by gradually decreasing rates during the late Pliocene and Quaternary. The average BSi accumulation during the middle Pliocene was ~3 times higher than maximum accumulation rates during the past 1.5 million years. The indicated progressive deterioration of environmental and climatic conditions in the Siberian Arctic starting at ca. 3.3 Ma is consistent with the first occurrence of glacial periods and the finally complete establishment of glacial-interglacial cycles during the Quaternary.
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A consistent use of the target language during English lessons is beneficial for pupils’ linguistic development, but also challenging for both teachers and pupils. The main purpose for pupils to learn English is to be able to use it in communication, which requires that they develop the ability to comprehend input, produce output and use language strategies. Several researchers claim that a consistent use of the target language is necessary in order to develop these abilities. Therefore, the aim of this study is to examine the target language use during English lessons in Swedish grades 4-6, and what pupils’ opinions regarding target language use are. The methods used to collect data consisted of a pupil questionnaire with 42 respondents and an observation of two teachers’ English lessons during a week’s time. The results from the observations show that the teachers use plenty of target language during lessons, but the first language as well to explain things that pupils might experience difficult to understand otherwise. The results from the questionnaire mainly show that the pupils seem to enjoy English and like to both speak and hear the target language during lessons. The main input comes from listening to a CD with dialogues and exercises in the textbook and the workbook, and from the teacher speaking. The results also show that a majority of the pupils use the target language in their spare time. A conclusion that can be drawn from this study is that the TL should be used to a large extent in order to support pupils’ linguistic development. However, teachers may sometimes need to use L1 in order to facilitate understanding of the things that many pupils find difficult, for example grammar. Suggestions for further research in this area include similar studies conducted on a larger scale.
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Objective: To estimate the prevalence and factors associated with the performance of mammography and pap smear test in women from the city of Maringá, Paraná. Methods: Population-based cross-sectional study conducted with 345 women aged over 20 years in the period from March 2011 to April 2012. An interview was carried out using a questionnaire proposed by the Ministry of Health, which addressed sociodemographic characteristics, risk factors for chronic noncommunicable diseases and issues related to mammographic and pap screening. Data were analyzed using bivariate analysis, crude analysis with odds ratio (OR) and chi-squared test using Epi Info 3.5.1 program; multivariate analysis using logistic regression was performed using the software Statistica 7.1, with a significance level of 5% and a confidence interval of 95%. Results: The mean age of the women was 52.19 (±5.27) years. The majority (56.5%) had from 0 to 8 years of education. Additionally, 84.6% (n=266) of the women underwent pap smear and 74.3% (n=169) underwent mammography. The lower performance of pap smear test was associated with women with 9-11 years of education (p=0.01), and the lower performance of mammography was associated with women without private health insurance (p<0.01). Conclusion: The coverage of mammography and pap smear test was satisfactory among the women from Maringá, Paraná. Low education level and women who depended on the public health system presented lower performance of mammography.
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The ongoing depletion of fossil fuels and the severe consequences of the greenhouse effect make the development of alternative energy systems crucially important. While hydrogen is, in principle, a promising alternative, releasing nothing but energy and pure water. Hydrogen storage is complicated and no completely viable technique has been proposed so far. This work is concerned with the study of one potential alternative to pure hydrogen: ammonia, and more specifically its storage in solids. Ammonia, NH3, can be regarded as a chemical hydrogen carrier with the advantages of strongly reduced flammability and explosiveness as compared to hydrogen. Furthermore, ammine metal salts presented here as promising ammonia stores easily store up to 50 wt.-% ammonia, giving them a volumetric energy density comparable to natural gas. The model system NiX2–NH3 ( X = Cl, Br, I) is studied thoroughly with respect to ammine salt formation, thermal decomposition, air stability and structural effects. The system CuX2–NH3 ( X = Cl, Br) has an adverse thermal decomposition behaviour, making it impractical for use as an ammonia store. This system is, however, most interesting from a structural point of view and some work concerning the study of the structural behaviour of this system is presented. Finally, close chemical relatives to the metal ammine halides, the metal ammine nitrates are studied. They exhibit interesting anion arrangements, which is an impressive showcase for the combination of diffraction and spectroscopic information. The characterisation techniques in this thesis range from powder diffraction over single crystal diffraction, spectroscopy, computational modelling, thermal analyses to gravimetric uptake experiments. Further highlights are the structure solutions and refinements from powder data of (NH4)2[NiCl4(H2O)(NH3)] and Ni(NH3)2(NO3)2, the combination of crystallographic and chemical information for the elucidation of the (NH4)2[NiCl4(H2O)(NH3)] formation reaction and the growth of single crystals under ammonia flow, a technique allowing the first documented successful growth and single crystal diffraction measurement for [Cu(NH3)6]Cl2.
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A cintigrafia óssea de corpo inteiro representa um dos exames imagiológicos mais frequentes realizados em medicina nuclear. Para além de outras aplicações, este procedimento é capaz de fornecer o diagnóstico de metástases ósseas. Em doentes oncológicos, a presença de metástases ósseas representa um forte indicador prognóstico da longevidade do doente. Para além disso, a presença ou ausência de metástases ósseas irá influenciar o planeamento do tratamento, requerendo para isso uma interpretação precisa dos resultados imagiológicos. Problema: Tendo em conta que a metastização óssea é considerada uma complicação severa relacionada com aumento da morbilidade e diminuição de sobrevivência dos doentes, o conceito de patient care torna-se ainda mais imperativo nestas situações. Assim, devem ser implementadas as melhores práticas imagiológicas de forma a obter o melhor resultado possível do procedimento efetuado, associado ao desconforto mínimo do doente. Uma técnica provável para atingir este objetivo no caso específico da cintigrafia óssea de corpo inteiro é a redução do tempo de aquisição, contudo, as imagens obtidas por si só teriam qualidade de tal forma reduzida que os resultados poderiam ser enviesados. Atualmente, surgiram novas técnicas, nomeadamente relativas a processamento de imagem, através das quais é possível gerar imagens cintigráficas com contagem reduzida de qualidade comparável àquela obtida com o protocolo considerado como standard. Ainda assim, alguns desses métodos continuam associados a algumas incertezas, particularmente no que respeita a sustentação da confiança diagnóstica após a modificação dos protocolos de rotina. Objetivos: O presente trabalho pretende avaliar a performance do algoritmo Pixon para processamento de imagem por meio de um estudo com fantoma. O objetivo será comparar a qualidade de imagem e a detetabilidade fornecidas por imagens não processadas com aquelas submetidas à referida técnica de processamento. Para além disso, pretende-se também avaliar o efeito deste algoritmo na redução do tempo de aquisição. De forma a atingir este objetivo, irá ser feita uma comparação entre as imagens obtidas com o protocolo standard e aquelas adquiridas usando protocolos mais rápidos, posteriormente submetidas ao método de processamento referido. Material e Métodos: Esta investigação for realizada no departamento de Radiologia e Medicina Nuclear do Radboud University Nijmegen Medical Centre, situado na Holanda. Foi utilizado um fantoma cilíndrico contendo um conjunto de seis esferas de diferentes tamanhos, adequado à técnica de imagem planar. O fantoma foi preparado com diferentes rácios de atividade entre as esferas e o background (4:1, 8:1, 17:1, 22:1, 32:1 e 71:1). Posteriormente, para cada teste experimental, o fantoma foi submetido a vários protocolos de aquisição de imagem, nomeadamente com diferentes velocidades de aquisição: 8 cm/min, 12 cm/min, 16 cm/min e 20 cm/min. Todas as imagens foram adquiridas na mesma câmara gama - e.cam Signature Dual Detector System (Siemens Medical Solutions USA, Inc.) - utilizando os mesmos parâmetros técnicos de aquisição, à exceção da velocidade. Foram adquiridas 24 imagens, todas elas submetidas a pós-processamento com recurso a um software da Siemens (Siemens Medical Solutions USA, Inc.) que inclui a ferramenta necessária ao processamento de imagens cintigráficas de corpo inteiro. Os parâmetros de reconstrução utilizados foram os mesmos para cada série de imagens, estando estabelecidos em modo automático. A análise da informação recolhida foi realizada com recurso a uma avaliação objetiva (utilizando parâmetros físicos de qualidade de imagem) e outra subjetiva (através de dois observadores). A análise estatística foi efetuada recorrendo ao software SPSS versão 22 para Windows. Resultados: Através da análise subjetiva de cada rácio de atividade foi demonstrado que, no geral, a detetabilidade das esferas aumentou após as imagens serem processadas. A concordância entre observadores para a distribuição desta análise foi substancial, tanto para imagens não processadas como imagens processadas. Foi igualmente demonstrado que os parâmetros físicos de qualidade de imagem progrediram depois de o algoritmo de processamento ter sido aplicado. Para além disso, observou-se ao comparar as imagens standard (adquiridas com 8 cm/min) e aquelas processadas e adquiridas com protocolos mais rápidos que: imagens adquiridas com uma velocidade de aquisição de 12 cm/min podem fornecer resultados melhorados, com parâmetros de qualidade de imagem e detetabilidade superiores; imagens adquiridas com uma velocidade de 16 cm/min fornecem resultados comparáveis aos standard, com valores aproximados de qualidade de imagem e detetabilidade; e imagens adquiridas com uma velocidade de 20 cm/min resultam em valores diminuídos de qualidade de imagem, bem como redução a nível da detetabilidade. Discussão: Os resultados obtidos foram igualmente estabelecidos por meio de um estudo clínico numa investigação independente, no mesmo departamento. Foram incluídos cinquenta e um doentes referidos com carcinomas da mama e da próstata, com o objetivo de estudar o impacto desta técnica na prática clínica. Os doentes foram, assim, submetidos ao protocolo standard e posteriormente a uma aquisição adicional com uma velocidade de aquisição de 16 cm/min. Depois de as imagens terem sido cegamente avaliadas por três médicos especialistas, concluiu-se que a qualidade de imagem bem como a detetabilidade entre imagens era comparável, corroborando os resultados desta investigação. Conclusão: Com o objetivo de reduzir o tempo de aquisição aplicando um algoritmo de processamento de imagem, foi demonstrado que o protocolo com 16 cm/min de velocidade de aquisição será o limite para o aumento dessa mesma velocidade. Após processar a informação, este protocolo fornece os resultados mais equivalentes àqueles obtidos com o protocolo standard. Tendo em conta que esta técnica foi estabelecida com sucesso na prática clínica, pode-se concluir que, pelo menos em doentes referidos com carcinomas da mama e da próstata, o tempo de aquisição pode ser reduzido para metade, duplicando a velocidade de aquisição de 8 para 16 cm/min.
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OBJECTIVES: We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG). SETTING AND SAMPLE POPULATION: A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007. MATERIALS AND METHODS: We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies. RESULTS: We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure. CONCLUSIONS: Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.
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Universidade Estadual de Campinas . Faculdade de Educação Física
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PURPOSE. To evaluate the effect of disease severity on the diagnostic accuracy of the Cirrus Optical Coherence Tomograph (Cirrus HD-OCT; Carl Zeiss Meditec, Inc., Dublin, CA) for glaucoma detection. METHODS. One hundred thirty-five glaucomatous eyes of 99 patients and 79 normal eyes of 47 control subjects were recruited from the longitudinal Diagnostic Innovations in Glaucoma Study (DIGS). The severity of the disease was graded based on the visual field index (VFI) from standard automated perimetry. Imaging of the retinal nerve fiber layer (RNFL) was obtained using the optic disc cube protocol available on the Cirrus HD-OCT. Pooled receiver operating characteristic (ROC) curves were initially obtained for each parameter of the Cirrus HD-OCT. The effect of disease severity on diagnostic performance was evaluated by fitting an ROC regression model, with VFI used as a covariate, and calculating the area under the ROC curve (AUCs) for different levels of disease severity. RESULTS. The largest pooled AUCs were for average thickness (0.892), inferior quadrant thickness (0.881), and superior quadrant thickness (0.874). Disease severity had a significant influence on the detection of glaucoma. For the average RNFL thickness parameter, AUCs were 0.962, 0.932, 0.886, and 0.822 for VFIs of 70%, 80%, 90%, and 100%, respectively. CONCLUSIONS. Disease severity had a significant effect on the diagnostic performance of the Cirrus HD-OCT and thus should be considered when interpreting results from this device and when considering the potential applications of this instrument for diagnosing glaucoma in the various clinical settings. (Invest Ophthalmol Vis Sci. 2010;51:4104-4109) DOI:10.1167/iovs.094716
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INTRODUCTION: Human cytomegalovirus (HCMV) is often reactive in latently infected immunosuppressed patients. Accordingly, HCMV remains one of the most common infections following solid organ and hemopoietic stem cell transplantations, resulting in significant morbidity, graft loss and occasional mortality. The early diagnosis of HCMV disease is important in immunosuppressed patients, since in these individuals, preemptive treatment is useful. The objective of this study was to compare the performance of the in-house qualitative polymerase chain reaction (PCR) and pp65 antigenemia to HCMV infection in immunosuppressed patients in the Hospital de Clínicas of Porto Alegre (HCPA). METHODS: A total of 216 blood samples collected between August 2006 and January 2007 were investigated. RESULTS: Among the samples analyzed, 81 (37.5%) were HCMV-positive by PCR, while 48 (22.2%) were positive for antigenemia. Considering antigenemia as the gold standard, sensitivity, specificity, positive predictive values and negative predictive values for PCR were 87.5%, 76.8%, 51.8% and 95.5% respectively. CONCLUSIONS: These results demonstrated that qualitative PCR has high sensitivity and negative predictive value (NPV). Consequently PCR is especially indicated for the initial diagnosis of HCMV infection. In the case of preemptive treatment strategy, identification of patients at high-risk for HCMV disease is fundamental and PCR can be useful tool.
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Degree of Doctor of Philosophy of Structural/Civil Engineering
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BACKGROUND: Pathogen reduction of platelets (PRT-PLTs) using riboflavin and ultraviolet light treatment has undergone Phase 1 and 2 studies examining efficacy and safety. This randomized controlled clinical trial (RCT) assessed the efficacy and safety of PRT-PLTs using the 1-hour corrected count increment (CCI(1hour) ) as the primary outcome. STUDY DESIGN AND METHODS: A noninferiority RCT was performed where patients with chemotherapy-induced thrombocytopenia (six centers) were randomly allocated to receive PRT-PLTs (Mirasol PRT, CaridianBCT Biotechnologies) or reference platelet (PLT) products. The treatment period was 28 days followed by a 28-day follow-up (safety) period. The primary outcome was the CCI(1hour) determined using up to the first eight on-protocol PLT transfusions given during the treatment period. RESULTS: A total of 118 patients were randomly assigned (60 to PRT-PLTs; 58 to reference). Four patients per group did not require PLT transfusions leaving 110 patients in the analysis (56 PRT-PLTs; 54 reference). A total of 541 on-protocol PLT transfusions were given (303 PRT-PLTs; 238 reference). The least square mean CCI was 11,725 (standard error [SE], 1.140) for PRT-PLTs and 16,939 (SE, 1.149) for the reference group (difference, -5214; 95% confidence interval, -7542 to -2887; p<0.0001 for a test of the null hypothesis of no difference between the two groups). CONCLUSION: The study failed to show noninferiority of PRT-PLTs based on predefined CCI criteria. PLT and red blood cell utilization in the two groups was not significantly different suggesting that the slightly lower CCIs (PRT-PLTs) did not increase blood product utilization. Safety data showed similar findings in the two groups. Further studies are required to determine if the lower CCI observed with PRT-PLTs translates into an increased risk of bleeding.
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In Nigeria, schistosomiasis, caused predominantly by the species Schistosoma haematobium, is highly endemic in resource-poor communities. We performed a school-based survey in two rural communities in Osun State (Southwestern Nigeria) and assessed macrohaematuria, microhaematuria and proteinuria as indirect indicators for the presence of disease. Urine samples were inspected macroscopically for haematuria and screened for microhaematuria and proteinuria using urine reagent strips. The microscopic examination of schistosome eggs was used as the gold standard for diagnosis. In total, 447 schoolchildren were included in this study and had a 51% prevalence of urinary schistosomiasis. The sensitivity of microhaematuria (68%) and proteinuria (53%) for infection with S. haematobium was relatively low. In patients with a heavy infection (>500 eggs/10 mL), the sensitivity of microhaematuria was high (95%). When the presence of macrohaematuria and the concomitant presence of microhaematuria and proteinuria were combined, it revealed a sensitivity of 63%, a specificity of 93% and a positive predictive value of 91%. Macrohaematuria also showed high specificity (96%) and a positive predictive value of 92%, while sensitivity was < 50%. These data show that combining urine reagent strip tests (presence of proteinuria and microhaematuria) and information on macrohaematuria increased the accuracy of the rapid diagnosis of urinary schistosomiasis in an endemic rural West African setting. This simple approach can be used to increase the quality of monitoring of schistosomiasis in schoolchildren.
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The advent of multiparametric MRI has made it possible to change the way in which prostate biopsy is done, allowing to direct biopsies to suspicious lesions rather than randomly. The subject of this review relates to a computer-assisted strategy, the MRI/US fusion software-based targeted biopsy, and to its performance compared to the other sampling methods. Different devices with different methods to register MR images to live TRUS are currently in use to allow software-based targeted biopsy. Main clinical indications of MRI/US fusion software-based targeted biopsy are re-biopsy in men with persistent suspicious of prostate cancer after first negative standard biopsy and the follow-up of patients under active surveillance. Some studies have compared MRI/US fusion software-based targeted versus standard biopsy. In men at risk with MRI-suspicious lesion, targeted biopsy consistently detects more men with clinically significant disease as compared to standard biopsy; some studies have also shown decreased detection of insignificant disease. Only two studies directly compared MRI/US fusion software-based targeted biopsy with MRI/US fusion visual targeted biopsy, and the diagnostic ability seems to be in favor of the software approach. To date, no study comparing software-based targeted biopsy against in-bore MRI biopsy is available. The new software-based targeted approach seems to have the characteristics to be added in the standard pathway for achieving accurate risk stratification. Once reproducibility and cost-effectiveness will be verified, the actual issue will be to determine whether MRI/TRUS fusion software-based targeted biopsy represents anadd-on test or a replacement to standard TRUS biopsy.