Sairaalan tarkkailuosaston hyödyt ja kustannukset

Työn tavoitteena oli tutkia Etelä-Karjalan keskussairaalaan mahdollisesti perustettavan yhdistelmätarkkailuosaston kannattavuutta määrittämällä osaston kustannukset ja hyödyt. Määritettyjen kustannusten avulla vertailtiin päivystys-potilaiden eri hoitoketjuvaihtoehtoja. Lähdeaineistona työssä käytettiin sairaalan omia materiaaleja ja tilastoja, henkilöstön haastatteluja sekä muita kirjallisuuslähteitä. Kirjallisuuden mukaan sairaalan ylikuormitus johtuu sen huonosta potilasvirtojen kulusta, jota voidaan parantaa joko toimintaa tehostamalla tai investoimalla uusiin resursseihin. Eräs vaihtoehto ylikuormituksen purkuun on tarkkailuosaston perustaminen, joka ei ole vain lisätila vaan potilasvirtojen ohjauskeino. Tehtyjen laskemien mukaan Etelä-Karjalan keskussairaalan tarkkailuosasto vaikuttaisi kannattavalta. Tarkkailuosaston kustannukset vuodessa olisivat 1 099 745 €, tuotot 1 170 108 € ja voitto 70 363 €. Osaston perustamiskustannukset olisivat 950 324 €. Hoitoketjujen potilaskohtaisen kannattavuuden mukaan päivystyspotilaiden tarkkailu ja lyhytaikainen hoito kannattaisi tehdä joko vuodeosastoilla tai tarkkailuosastolla, mutta ei tappiota tuottavalla ensiapupoliklinikalla. Tarkkailuosastosta olisi taloudellisten tekijöiden lisäksi myös muita hyötyjä ja haittoja sairaalan sidosryhmille. Sairaalan valitsemasta ylikuormituksen vähentämiskeinosta riippumatta, on sen tärkeätä aloittaa jo lähivuosina valmistautuminen väestön ikääntymisen aiheuttamaan lisääntyvään kuormitukseen.

AVALIAÇÃO FENOLÓGICA DAS DIFERENTES ESTRUTURAS DE FRUTIFICAÇÃO DAS MACIEIRAS 'GALA' E 'FUJI' NA REGIÃO DE CAÇADOR-SC

RESUMO A macieira apresenta duas fases que caracterizam seu ciclo anual: a de repouso hibernal e a de crescimento vegetativo e reprodutivo. A importância em se conhecer ainfluência das condições climáticas sobre os processos reprodutivos das plantas e em desenvolver tecnologias que minimizem os possíveis efeitos aumenta à medida que as projeções de aquecimento global se tornampreocupantes. O objetivo deste trabalho foi caracterizar o comportamento dos principais eventos fenológicos da macieira, da brotação à colheita, nas diferentes estruturas de frutificação, sob as condiçõesclimáticas do Sul do Brasil. O estudo experimental foi conduzido na Estação Experimental da Epagri (26°50’S, 50°58’W, altitude 950 m), durante os ciclos de 2011/12 e 2013/2014. As cultivares estudadas foram Gala e Fuji,com nove anos de idade, ambas sobre o porta-enxerto M9. O desenvolvimento fenológico foi observado nas diferentes estruturas de frutificação da macieira: gema de esporão, gema terminal de brindila e gemaaxilar de brindilas. As mesmas foram comparadas através dos dias e da exigência térmica necessários para a transição dos estádios, sendo contabilizados a partir do tratamento de quebra de dormência. As diferençasencontradas no início da brotação e do florescimento, entre as estruturas, dependeram consideravelmente das condições climáticas do ano em questão. Sob condições de altas temperaturas após o tratamento de quebra dedormência, houve maior sincronia fenológica entre as estruturas, sendo que sob baixas temperaturas se observou maior variabilidade dos estádios entre as mesmas. A partir do tratamento de quebra de dormência,gemas de esporões necessitam de menor acúmulo térmico para brotar, principalmente esporões de ‘Gala’ e gemas terminais de brindilas necessitam de maior acúmulo térmico que gemas de esporões para dar início aoflorescimento.

Dépistage du risque d'allergie et prévention en maternité : enquête des pratiques AllerNaiss [Screening for the risk of allergy and prevention in French maternity units: A survey].

Allergy has been on the rise for half a century and concerns nearly 30% of children; it has now become a real public health problem. The guidelines on prevention of allergy set up by the French Society of Paediatrics (SFP) and the European Society of Paediatric Allergology and Clinical Immunology (ESPACI) are based on screening children at risk through a systematic search of the family history and recommend, for children at risk, exclusive breastfeeding whenever possible or otherwise utilization of hypoallergenic infant formula, which has demonstrated efficacy. The AllerNaiss practice survey assessed the modes of screening and prevention of allergy in French maternity units in 2012. The SFP guidelines are known by 82% of the maternity units that took part in the survey, and the ESPACI guidelines by 55% of them. A screening strategy is in place in 59% of the participating maternity wards, based on local consensus for 36% of them, 13% of the units having a written screening procedure. Screening is based on the search for a history of allergy in first-degree relatives (99%) during pregnancy (51%), in the delivery room (50%), and after delivery (89%). A mode of prevention of the risk of allergy exists in 62% of the maternity units, most often in writing (49%). A hypoallergenic infant formula is prescribed for non-breastfed children in 90% of the units. The survey shows that there is a real need for formalization of allergy risk screening and prevention of allergy in newborns in French maternity units.

Foreign-Medical-School Graduates object to the VISA Qualifiying Examination

To the editor; The Visa Qualifying Examination is a two-day test composed of approximately 950 multiple-choice questions conerneing the basic and clinical sciences....

Psykologi

Samlingen omfattar huvudsakligen psykologisk litteratur med anknytning till personaladministration, arbetsliv, reklam, motivation. Tillgång till c.950 elektroniska böcker (ebrary) och 15 databaser med delvis psykologisk information (licensbaserat material). Psykologista kirjallisuutta liittyen lähinnä henkilöstöhallintoon, työelämään, mainontaan ja motivaatioon. N. 950 e-kirjaa (ebrary) ja 15 tietokantaa (vaatii lisenssin).

Tricobezoar gástrico gigante: relato de caso e revisão da literatura

Os autores descrevem um caso de massa abdominal epigástrica palpável associada a sintomas dispépticos em uma paciente jovem sem antecedentes patológicos. Estudos por imagem evidenciaram corpo estranho gástrico de "aspecto enovelado". A paciente foi submetida a gastrotomia via laparotomia, com retirada de um tricobezoar de 1.950 gramas.

Preparação e caracterização de pós cerâmicos de aluminatos de lítio

The preparation of gamma-LiAlO2 by coprecipitation and sol-gel synthesis was investigated. Ceramic powders obtained by coprecipitation synthesis were prepared from aqueous solutions of aluminum and lithium nitrates using sodium hydroxide as precipitant agent. By sol-gel synthesis, the ceramic powders were prepared from hydrolysis of aluminum isopropoxide. The materials obtained by two routes of synthesis were dried at 80ºC and calcined at 550, 750, 950 and 1150ºC. The characterization was done by X-ray diffraction, infrared spectroscopy, emission and absorption atomic spectrometry, helium picnometry, specific surface area (BET method) and scanning electronic microscopy. Mixtures of crystalline phases were obtained by coprecipitation synthesis: 80ºC- LiAl2(OH)7.2H2O + Al(OH)3; 550 and 750ºC- alpha-LiAlO2 + eta-Al2O3; 950 and 1150ºC- gamma-LiAlO2 + LiAl5O8. Chemical analysis showed molar ration Al/Li @ 3. Crystalline single-phases were obtained by sol-gel synthesis above 550ºC: 550ºC-alpha-LiAlO2; 750, 950 and 1150ºC-gamma-LiAlO2. These powders presented molar ration Al/Li @ 1. Thus, gamma-LiAlO2 crystalline phase was obtained at 750ºC by sol-gel synthesis while by coprecipitation synthesis, a mixture of crystalline phases was obtained. These results showed the superiority of the sol-gel synthesis for the preparation of pure gamma-LiAlO2.

Morphological study of Sr2CeO4 blue phosphor with fine particles

Morphological and spectroscopic studies of Sr2CeO4 blue phosphor in the form of fine particles prepared from a powdered multi-component precursor, via a combustion method, are reported. Samples were also prepared through a solid-state reaction and from a polymeric precursor for comparison. Citric acid or glycine as fuels in the combustion method lead to a mixture which is heated at 950 ºC for 4 h, resulting in spheroidal particles with a diameter between 250-550 nm. Samples from the polymeric precursor result in spheroidal particles (350-550 nm) and from the solid-state reaction in irregular particles (~ 5 mum). Therefore, the combustion method is adequate for preparation of Sr2CeO4 in the form of spherical fine particles.

Estudo termogravimétrico do efeito da temperatura e da atmosfera na absorção de dióxido de enxofre por calcário

Thermogravimetry was applied to investigate the effects of temperature and atmosphere on conversion of sulfur dioxide (SO2) absorbed by limestone. Ranges of temperature and particle size were studied, typical of fluidized-bed coal combustion. Isothermal experiments were performed at different temperatures (between 750 and 950 ºC) under local atmospheric pressure (~ 697 mmHg) in dynamic atmospheres of air and nitrogen. The maximum conversion was 29% higher in nitrogen atmosphere than in air atmosphere. The optimum conversion temperature was found at 831 ºC in air atmosphere and at 894 ºC in nitrogen atmosphere.

Determinação dos parâmetros de arrhenius da reação de sorção do dióxido de enxofre por calcário

Sulfur emission in coal power generation is a matter of great environmental concern and limestone sorbents are widely used for reducing such emissions. Thermogravimetry was applied to determine the effects of the type of limestone (calcite and dolomite), particle size (530 and 650 µm) and atmosphere (air and nitrogen) on the kinetics of SO2 sorption by limestone. Isothermal experiments were performed for different temperatures (650 to 950 ºC), at local atmospheric pressure. The apparent activation energies, as indicated by the slope of the Arrhenius plot, resulted between 3.03 and 4.45 kJ mol-1 for the calcite, and 11.24 kJ mol-1 for the dolomite.

Utilização do acetato de celulose produzido a partir da celulose extraída do caroço de manga como matriz para produção de sistemas microparticulados

Cellulose acetate produced from mango seed fibers cellulose was used as a matrix for preparation of microparticles empty and load with acetaminophen (Paracetamol) in order to evaluate the incorporation of an active agent during the formation of microparticles. The microparticles are characterized by Fourier Transformed Infrared spectroscopy (FTIR), Differential Scanning Calorimetry (DSC) and Scanning Electron Microscopy (SEM). The incorporation of paracetamol can be confirmed by the change in value of glass transition temperature (Tg). The formation of microparticles spherical was observed by SEM and showed an average diameter of 1.010 and 0.950 mm for empty and load microparticles respectively.

Frações da matéria orgânica e propriedades redox de substâncias húmicas em sedimentos de oceanos profundos

Previous studies have verified that free radicals such as quinone moieties in organic matter participate in the redox reactions in natural systems. These functional groups were positively correlated with the increase in aromaticity and hydrophobicity of the humic substances. As an alternative to relatively complex and expensive spectroscopic methods, the redox properties of the humic substances, determined by potentiometric titrations, have been used to evaluate organic carbon stability in soil and sediments. The present study aimed to perform organic matter fractionation and isolation of humic substances from deep oceans in different isobaths (750; 1,050; 1,350; 1,650; 1,950 m) to determine their redox properties by iodimetric titrations under an inert atmosphere and specified conditions of pH and ionic strength. Sediment samples were collected to the North and South of platforms of petroleum exploration located in the North of Rio de Janeiro State, Brazil. Fractions of organic carbon and redox properties of humic substances varied with origin and depth of the samples and with position North and South of the petroleum exploration area.

Rekiveisu

Soitinnus: melodia.

The Methods of Possible Joint Treatment of Manure and Sewage Sludge in the Leningrad Region

The nutrient load to the Gulf of Finland has started to increase as a result of the strong economic recovery in agriculture and livestock farming in the Leningrad region. Also sludge produced from municipal wastewater treatment plant of the Leningrad region causes the great impact on the environment, but still the main options for its treatment is disposal on the sludge beds or Landfills. The aim of this study was to evaluate the implementation of possible joint treatment methods of manure form livestock and poultry enterprises and sewage sludge produced from municipal wastewater treatment plants in the Leningrad region. The study is based on published data. The most attention was put on the anaerobic digestion and incineration methods. The manure and sewage sludge generation for the whole Leningrad region and energy potential produced from their treatment were estimated. The calculations showed that total amount of sewage sludge generation is 1 348 000 t/a calculated on wet matter and manure generation is 3 445 000 t/a calculated on wet matter. The potential heat release from anaerobic digestion process and incineration process is 4 880 000 GJ/a and 5 950 000 GJ/a, respectively. Furthermore, the work gives the overview of the general Russian and Finnish legislation concerning manure and sewage sludge treatment. In the Gatchina district it was chosen the WWTP and livestock and poultry enterprises for evaluation of the centralized treatment plant implementation based on anaerobic digestion and incineration methods. The electricity and heat power of plant based on biogas combustion process is 4.3 MW and 7.8 MW, respectively. The electricity and heat power of plant based on manure and sewage sludge incineration process is 3.0 MW and 6.1 MW, respectively.