Current Sheet Regulation of Solar Near-Relativistic Electron Injection Histories

We present a sample of three large near-relativistic (>50 keV) electron events observed in 2001 by both the ACE and the Ulysses spacecraft, when Ulysses was at high-northern latitudes (>60°) and close to 2 AU. Despite the large latitudinal distance between the two spacecraft, electrons injected near the Sun reached both heliospheric locations. All three events were associated with large solar flares, strong decametric type II radio bursts and accompanied by wide (>212°) and fast (>1400 km s-1) coronal mass ejections (CMEs). We use advanced interplanetary transport simulations and make use of the directional intensities observed in situ by the spacecraft to infer the electron injection profile close to the Sun and the interplanetary transport conditions at both low and high latitudes. For the three selected events, we find similar interplanetary transport conditions at different heliolatitudes for a given event, with values of the mean free path ranging from 0.04 AU to 0.27 AU. We find differences in the injection profiles inferred for each spacecraft. We investigate the role that sector boundaries of the heliospheric current sheet (HCS) have on determining the characteristics of the electron injection profiles. Extended injection profiles, associated with coronal shocks, are found if the magnetic footpoints of the spacecraft lay in the same magnetic sector as the associated flare, while intermittent sparse injection episodes appear when the spacecraft footpoints are in the opposite sector or a wrap in the HCS bounded the CME structure.

Orthoptic Sequelae Following Conservative Management of Pure Blowout Orbital Fractures: Anecdotal or Clinically Relevant?

The aim of this study was to prospectively assess the prevalence of orthoptic anomalies following conservative management of pure blowout orbital fractures and to evaluate their clinical relevance. Clinical and radiologic data of patients with unilateral conservatively managed pure blowout orbital fractures with a minimum follow-up of 6 months were reviewed. Eligible patients were contacted and invited to undergo an extended ophthalmologic examination as follows: distance and near visual acuities, Hertel exophthalmometry, corneal light reflex (Hirschberg test), ductions and versions in the 6 cardinal fields of gaze, eye deviation with prisms and alternate cover test in all of the 9-gaze directions with Maddox rod, degrees of incyclo/excyclotorsion with right and left eye fixation, horizontal and vertical deviation with Hess-Weiss coordimetry, degree of horizontal/vertical and incyclo/excyclotorsion deviation with Harms wall deviometry, and vertical deviation with Bielschowsky head-tilt test. Of the 69 patients contacted, 49 declined to participate given that they were asymptomatic. Twenty patients agreed to undergo the examination. One patient complained of minimal double vision limited to the extreme downgaze. Four patients had asymptomatic ocular motility disturbances limited to the extreme gaze. Seven patients had asymptomatic horizontal heterophoria. These disturbances did not interfere with daily or professional activities in any of the patients. The current study demonstrated that conservative management of pure orbital blowout fractures can result in orthoptic anomalies. These sequelae were restricted to a very limited portion of the binocular field of the vision and were not found to be clinically relevant.

Is Switzerland doing enough regarding the prevention of syphilis, gonorrhea and chlamydia infections ?

Sexually transmitted infections are a major problem for medicine and for public health services worldwide. More than 30 sexually transmittable pathogenic micro-organisms are known, including bacteria, viruses, fungi, protozoa and ectoparasites. According to estimates from the World Health Organisation more than 333 million of bacterial sexually transmitted infections occur worldwide per year. Sexually transmitted infections, by their nature, affect individuals, within partnerships and larger sexual networks, and in turn populations. This report focuses on three bacterial sexually transmitted infections in Switzerland that are Chlamydia trachomatis, Neisseria gonorrhea and Treponema pallidum (syphilis) in Switzerland. The prevalence of these infections has been increasing alarmingly for a decade. All three infections can be asymptomatic and their diagnosis and treatment can therefore occur too late or worse not at all, even though treatments are available. This is an important problem as untreated sexually transmitted infections may cause complications such as ascending infections, infertility, ectopic pregnancies and serious long-term neurological sequels. The consequences of these infections should not be underestimated. They constitute a significant public health burden as well as serious financial burden. The increases in chlamydia, syphilis and gonorrhea infections have also been observed in many European countries. Countries, where rising numbers of sexually transmitted infections have been observed, have reacted in different ways. Some have developed clinical guidelines or implemented screening programs, while others are still in their observational phase. The aim of this mémoire is to assess whether Switzerland is doing enough regarding the prevention of chlamydial, syphilis and gonorrheal infections. After first describing the infections, surveillance systems of sexually transmitted infections are assessed, then the epidemiological trends of these three infections are described, and finally the prevention measures implemented in Switzerland to respond to the increasing number of infections are described. The reaction of the United Kingdom to the same problem is reported for comparison. [Author, p. 7]

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants.

One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. We used data from 751 studies including 4,372,000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-7.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. Wellcome Trust.

Radio continuum and near-ingrared study of the MGRO J2019+37 region

Context. MGRO J2019+37 is an unidentified extended source of very high energy gamma-rays originally reported by the Milagro Collaboration as the brightest TeV source in the Cygnus region. Its extended emission could be powered by either a single or several sources. The GeV pulsar AGL J2020.5+3653, discovered by AGILE and associated with PSR J2021+3651, could contribute to the emission from MGRO J2019+37. Our aim is to identify radio and near-infrared sources in the field of the extended TeV source MGRO J2019+37, and study potential counterparts to explain its emission. Methods: We surveyed a region of about 6 square degrees with the Giant Metrewave Radio Telescope (GMRT) at the frequency 610 MHz. We also observed the central square degree of this survey in the near-infrared Ks-band using the 3.5 m telescope in Calar Alto. Archival X-ray observations of some specific fields are included. VLBI observations of an interesting radio source were performed. We explored possible scenarios to produce the multi-TeV emission from MGRO J2019+37 and studied which of the sources could be the main particle accelerator. Results: We present a catalogue of 362 radio sources detected with the GMRT in the field of MGRO J2019+37, and the results of a cross-correlation of this catalog with one obtained at near-infrared wavelengths, which contains ∼3 × 105 sources, as well as with available X-ray observations of the region. Some peculiar sources inside the ∼1◦ uncertainty region of the TeV emission from MGRO J2019+37 are discussed in detail, including the pulsar PSR J2021+3651 and its pulsar wind nebula PWN G75.2+0.1, two new radio-jet sources, the Hii region Sh 2-104 containing two star clusters, and the radio source NVSS J202032+363158. We also find that the hadronic scenario is the most likely in case of a single accelerator, and discuss the possible contribution from the sources mentioned above. Conclusions: Although the radio and GeV pulsar PSR J2021+3651 / AGL J2020.5+3653 and its associated pulsar wind nebula PWN G75.2+0.1 can contribute to the emission from MGRO J2019+37, extrapolation of the GeV spectrum does not explain the detected multi-TeV flux. Other sources discussed here could contribute to the emission of the Milagro source

Determining risk potential through accidents and near-accidents: an empirical study in a steel factory

Fatal and permanently disabling accidents form only one per I cent of all occupational accidents but in many branches of industry they account for more than half the accident costs. Furthermore the human suffering of the victim and his family is greater in severe accidents than in slight ones. For both human and economic reasons the severe accident risks should be identified befor injuries occur. It is for this purpose that different safety analysis methods have been developed . This study shows two new possible approaches to the problem.. The first is the hypothesis that it is possible to estimate the potential severity of accidents independent of the actual severity. The second is the hypothesis that when workers are also asked to report near accidents, they are particularly prone to report potentially severe near accidents on the basis of their own subjective risk assessment. A field study was carried out in a steel factory. The results supported both the hypotheses. The reliability and the validity of post incident estimates of an accident's potential severity were reasonable. About 10 % of accidents were estimated to be potentially critical; they could have led to death or very severe permanent disability. Reported near accidents were significantly more severe, about 60 $ of them were estimated to be critical. Furthermore the validity of workers subjective risk assessment, manifested in the near accident reports, proved to be reasonable. The studied new methods require further development and testing. They could be used both in routine usage in work places and in research for identifying and setting the priorities of accident risks.

Performance Improvement of Centrifugal Compressor Stage with Pinched Geometry or Vaned Diffuser

Centrifugal compressors are widely used for example in refrigeration processes, the oil and gas industry, superchargers, and waste water treatment. In this work, five different vaneless diffusers and six different vaned diffusers are investigated numerically. The vaneless diffusers vary only by their diffuser width, so that four of the geometries have pinch implemented to them. Pinch means a decrease in the diffuser width. Four of the vaned diffusers have the same vane turning angle and a different number of vanes, and two have different vane turning angles. The flow solver used to solve the flow fields is Finflo, which is a Navier-Stokes solver. All the cases are modeled with the Chien's k – έ- turbulence model, and selected cases are modeled also with the k – ώ-SST turbulence model. All five vaneless diffusers and three vaned diffusers are investigated also experimentally. For each construction, the compressor operating map is measured according to relevant standards. In addition to this, the flow fields before and after the diffuser are measured with static and total pressure, flow angle and total temperature measurements. When comparing the computational results to the measured results, it is evident that the k – ώ-SST turbulence model predicts the flow fields better. The simulation results indicate that it is possible to improve the efficiency with the pinch, and according to the numerical results, the two best geometries are the ones with most pinch at the shroud. These geometries have approximately 4 percentage points higher efficiency than the unpinched vaneless diffusers. The hub pinch does not seem to have any major benefits. In general, the pinches make the flow fields before and after the diffuser more uniform. The pinch also seems to improve the impeller efficiency. This is down to two reasons. The major reason is that the pinch decreases the size of slow flow and possible backflow region located near the shroud after the impeller. Secondly, the pinches decrease the flow velocity in the tip clearance, leading to a smaller tip leakage flow and therefore slightly better impeller efficiency. Also some of the vaned diffusers improve the efficiency, the increment being 1...3 percentage points, when compared to the vaneless unpinched geometry. The measurement results confirm that the pinch is beneficial to the performance of the compressor. The flow fields are more uniform with the pinched cases, and the slow flow regions are smaller. The peak efficiency is approximately 2 percentage points and the design point efficiency approximately 4 percentage points higher with the pinched geometries than with the un- pinched geometry. According to the measurements, the two best geometries are the ones with the most pinch at the shroud, the case with the pinch only at the shroud being slightly better of the two. The vaned diffusers also have better efficiency than the vaneless unpinched geometries. However, the pinched cases have even better efficiencies. The vaned diffusers narrow the operating range considerably, whilst the pinch has no significant effect on the operating range.

Sistemes logístics de codificació i identificació, i perspectives de futur

Comptar amb sistemes sofisticats de gestió o programes ERP (Enterprise Resource Planning) no és suficient per a les organitzacions. Per a què aquests recursos donin resultats adequats i actualitzats, la informació d’entrada ha de llegir-se de forma automàtica, per aconseguir estalviar en recursos, eliminació d’errors i assegurar el compliment de la qualitat. Per aquest motiu és important comptar amb eines i serveis d’identificació automàtica i col•lecció de dades. Els principals objectius a assolir (a partir de la introducció al lector de la importància dels sistemes logístics d’identificació en un entorn global d’alta competitivitat), són conèixer i comprendre el funcionament de les tres principals tecnologies existents al mercat (codis de barres lineals, codis de barres bidimensionals i sistemes RFID), veure en quin estat d’implantació es troba cadascuna i les seves principals aplicacions. Un cop realitzat aquest primer estudi es pretén comparar les tres tecnologies per o poder obtenir perspectives de futur en l’àmbit de l’autoidentificació. A partir de la situació actual i de les necessitats de les empreses, juntament amb el meravellós món que sembla obrir la tecnologia RFID (Radio Frequency Identification), la principal conclusió a la que s’arribarà és que malgrat les limitacions tècniques dels codis de barres lineals, aquests es troben completament integrats a tota la cadena logística gràcies a l’estandarització i la utilització d’un llenguatge comú, sota el nom de simbologies GTIN (Global Trade Item Number), durant tota la cadena de subministres que garanteixen total traçabilitat dels productes gràcies en part a la gestió de les bases de dades i del flux d’informació. La tecnologia RFUD amb l’EPC (Electronic Product Code) supera aquestes limitacions, convertint-se en el màxim candidat per a substituir els limitats codis de barres. Tot i això, RFID, amb l’EPC, no serà un adequat identificador logístic fins que es superin importants barreres, com són la falta d’estandarització i l’elevat cost d’implantació.

Utilizing Near Field Communication in Health Care

In this master’s thesis, possibilities to utilize Near Field Communication (NFC) technology in health care applications are examined. NFC is a short-range wireless communication technology that enables the exchange of data between devices. Main components in NFC are tag, which contains data, a NFC reader device, which can be for instance embedded to mobile phone and also act as a tag, and an antennae in both tag and reader. In this work NFC technology is discussed and its utilization in health care information systems that are in use or in trial. Utilization of information technology in health care field is examined superficially. In this thesis, a system utilizing NFC is designed and its requirements and architecture presented. NFC is used in identification of care worker. When care worker arrives at the house of a patient, she brings the NFC-enabled mobile phone near NFC tag. This sends information to the application server. This information contains the time of arrival and patient and location identifier. When care worker leaves the place, she repeats the procedure. Information gathered can be used in reporting and real time tracking.

Christina Rossetti's "Goblin market" : Milton revised or revived?

The present study examines Christina Rossetti's (1830-94) best-known poem "Goblin Market" (1859) as a response to John Milton's (1608-74) Paradise Lost (1667) and Paradise Regained (1674). Rossetti's poem relates to Milton's twin epics with a surprising degree of complexity, something that the thesis demonstrates through a large number of hitherto unexplored textual parallels. In its recontextualisation of Rossetti's poetry, this study balances interpretative strategies evolved by feminism with more historicist readings. SinceGilbert and Gubar's landmark feminist work of 1979, it has become something of a critical commonplace that Milton was a figure of patriarchal oppression whom women writers have challenged through revision. As a consequence, intertextual Rossetti studies have tended to emphasise such a revisionist element in her achievement. But if we place "Goblin Market" within the larger context of Rossetti's thoughts on religion and poetry throughout her writing, and if we de-emphasise the dichotomy between Rossetti and her male precursor, alternative patterns of reading begin to emerge. This thesis argues that Rossetti's aim was not only to revise Milton but also to revive him. It develops this point in several ways: first, by introducing the subject and theoretically arguing that literary allusiveness is not necessarily a matter of oedipal or feminist envy only (Chapter One); second, by determining the nature and extent of Rossetti's Miltonic allusions in terms of theme, imagery and language (Chapter Two);and third, by examining their function in terms of argument (Chapters Three andFour). I n an age of increasing religious doubt, Rossetti's poetry provided a subtle challenge not so much to Milton as to the emerging scepticism and aestheticism in Victorian society and its art-world, and not least to the secular tendencies of the second generation of Pre-Raphaelites, including Dante Gabriel Rossetti. Christina Rossetti was ahead of her time (and perhaps ours) in seeing the feminist potential in both John Milton and the Christian message. In the soul's relation to Christ, gender does not matter. What matters is the individual's quest for salvation, a quest in which poetry is a sacramental act, with a transformative, unifying function. Rossetti's poems both depict and constitute such a quest for union with God, on the assumption that God's word offers a pathway that is open to men as well as women.

Metsäsääntely Suomessa ja Venäjällä. Näkökulmia kestävään metsätalouteen

Sustainability is the aim of forest management and forest regulation in many countries. Accordingly, forest management has been steered towards more environmentally friendly methods and new regulatory instruments have been introduced. At the same time, wood trade and forest industry have become a global business. Even if the importance of national forest legislation has not decreased, it has been widely acknowledged that national regulation of forest management is no longer sufficient. The movement of goods does not acknowledge boundaries, even though most negative environmental and social consequences stay in the country of origin of wood and other raw materials. As a partial solution to this dilemma, different kinds of regulations have been developed. Various forest certification schemes and wood trade regulation in the EU (995/2010) are examples of efforts to prevent illegal logging and unsustainable forestry. The Finland-based forest industry is to a varying extent dependent on wood trade from Russia. Especially in the 1990‟s, ethical questions concerning import of wood from Russian old growth forests near the Finnish border were widely discussed. Consequently, forest industry enterprises have developed systems to trace the origin of wood and to buy certified wood from Russia. The aim of the research has been to evaluate Finnish and Russian forest regulations in order to investigate what kind of forest management these regulations enhance, and to what extent ecologically sustainable forest management has been integrated into different forms of regulation. I have examined Finnish and Russian forest regulation in four separate articles based on the topics of the Russian Forest Code, forest certification and other voluntary forest protection measures in Russia, Finnish forest certification and Finnish forest legislation. One objective has been to analyse the roles voluntary forest certification plays in promoting sustainable forest management in different countries. In my research, I have mainly concentrated on ecological sustainability and protection of biodiversity, although other aspects of sustainable forest management have been touched upon in different articles. In the following I shall conclude the findings of my research. When the current Russian Forest Code (2006) was being adopted, the main emphasis was not on ecological issues, but on reorganizing forest governance. The role of ecological requirements was even slightly diminished during the legislative reform. There are, nevertheless, still stipulations aiming at ecological sustainability, such as the division of forests into different forest management categories and various protection zones. In 2000, FSC forest certification arrived in Russia, at present covering already 28 million hectares of forests. The PEFC scheme is now in use as well, but to a much lesser extent. If properly implemented, Russian forest certification schemes clearly improve the level of ecological and social sustainability of forestry in Russia. Certification criteria, however, are partly in conflict with the Russian forest legislation and certified enterprises have been forced to pay fines or to negotiate with forest authorities. This clearly indicates that even if Russian forest legislation has otherwise been liberalized to a certain extent, some significant paternalism still exists. Voluntary, hands-on biodiversity protection measures are not valued, and they are not part of the official protection policies as in many other countries. However, there have been some regional solutions to this dilemma. In the Republic of Karelia forest authorities have approved a set of forest biodiversity protection rules created by a local NGO and a forest industry enterprise. By following these local rules, an enterprise can avoid fines for protection measures. The current Finnish Forest Act was adopted in 1996. It brought forest legislation into a new era as some ecological aspects were integrated into forest legislation. The various soft-law forest management recommendations further increased the level of biodiversity protection. My evaluation of the overall legitimacy of the Finnish forest legislation and forest management paradigm revealed, however, several problematic issues. As part of this study I analysed the history of the current forest management paradigm. This analysis revealed the path dependency which still hinders the protection of biodiversity and clearly decreases the general legitimacy of forest management. Due to several historical reasons only even-structured forest management based on clear cuts has for decades been officially approved in Finland. Due to increasing demands of forest owners the legislation is finally being revised. Yet, the official approval of uneven-structured forest management would not be enough to fully improve ecological, social and cultural legitimacy. The latest ecological theories and knowledge of endangered species should be taken into account in the on-going reform of forest legislation as well as the modernisation. Forest legislation is one of the very few spheres of Finnish environmental legislation where openness and participation are still considered a threat. The first Finnish forest certification scheme, PEFC, was established in 2000. It now covers more than 20 million hectares, about 95% of the forests in Finland. PEFC Finland does not require a higher level of biodiversity protection than the recommendations by Tapio (the Development Centre for Forestry), but certification has unified forest management practices and requires more protection measures than mere forest legislation. The study suggests that in Finland PEFC has not functioned as an instrument which would substantially improve the level of forest management. Rather it has supported the status quo of the forest sector. While the ecological and social responsibility of Finland-based forest corporations was one impetus for this research, I want to conclude that there are problems related to forest legislation and non-state regulation in both Finland and Russia. If an enterprise buying wood from Russia buys only certified wood, and carefully avoids wood coming from high conservation value forests that are either ecologically or socially valuable, it can be claimed to be as sustainably produced as in Finland. However, there must be continuous scrutiny of the circumstances. In Russia, the level of the compliance of certification criteria varies considerably, and there are vast unprotected invaluable forest areas. The utilisation of these areas should not be based on short-sighted decisions or lack of consensus among stakeholders.

CFD Modelling of Direct Contact Condensation in Suppression Pools by Applying Condensation Models of Separated Flow

The condensation rate has to be high in the safety pressure suppression pool systems of Boiling Water Reactors (BWR) in order to fulfill their safety function. The phenomena due to such a high direct contact condensation (DCC) rate turn out to be very challenging to be analysed either with experiments or numerical simulations. In this thesis, the suppression pool experiments carried out in the POOLEX facility of Lappeenranta University of Technology were simulated. Two different condensation modes were modelled by using the 2-phase CFD codes NEPTUNE CFD and TransAT. The DCC models applied were the typical ones to be used for separated flows in channels, and their applicability to the rapidly condensing flow in the condensation pool context had not been tested earlier. A low Reynolds number case was the first to be simulated. The POOLEX experiment STB-31 was operated near the conditions between the ’quasi-steady oscillatory interface condensation’ mode and the ’condensation within the blowdown pipe’ mode. The condensation models of Lakehal et al. and Coste & Lavi´eville predicted the condensation rate quite accurately, while the other tested ones overestimated it. It was possible to get the direct phase change solution to settle near to the measured values, but a very high resolution of calculation grid was needed. Secondly, a high Reynolds number case corresponding to the ’chugging’ mode was simulated. The POOLEX experiment STB-28 was chosen, because various standard and highspeed video samples of bubbles were recorded during it. In order to extract numerical information from the video material, a pattern recognition procedure was programmed. The bubble size distributions and the frequencies of chugging were calculated with this procedure. With the statistical data of the bubble sizes and temporal data of the bubble/jet appearance, it was possible to compare the condensation rates between the experiment and the CFD simulations. In the chugging simulations, a spherically curvilinear calculation grid at the blowdown pipe exit improved the convergence and decreased the required cell count. The compressible flow solver with complete steam-tables was beneficial for the numerical success of the simulations. The Hughes-Duffey model and, to some extent, the Coste & Lavi´eville model produced realistic chugging behavior. The initial level of the steam/water interface was an important factor to determine the initiation of the chugging. If the interface was initialized with a water level high enough inside the blowdown pipe, the vigorous penetration of a water plug into the pool created a turbulent wake which invoked the chugging that was self-sustaining. A 3D simulation with a suitable DCC model produced qualitatively very realistic shapes of the chugging bubbles and jets. The comparative FFT analysis of the bubble size data and the pool bottom pressure data gave useful information to distinguish the eigenmodes of chugging, bubbling, and pool structure oscillations.

Fatores associados à gravidade da morbidade materna na caracterização do near miss

OBJETIVOS: aplicar um escore de gravidade em casuística de morbidade materna grave (MMG) e comparar os critérios para classificação. MÉTODOS: estudo caso-controle como análise secundária de casuística de MMG de maternidade terciária em período de 12 meses. Nos casos identificados de MMG, aplicou-se escore específico para graduação da gravidade. Vinte casos de morbidade materna near miss (maior gravidade) foram comparados com 104 controles (menor gravidade) de outras morbidades, quanto a fatores de risco, determinantes primários e demanda assistencial. A análise incluiu o cálculo de médias e proporções, utilizando os testes estatísticos t de Student, Wilcoxon, chi2 e estimativas de OR e IC 95%. RESULTADOS: a maior gravidade (near miss) foi identificada em 16,1% da casuística e o antecedente de aborto foi o único fator significativamente a ela associado (OR=3,41; IC 95%=1,08-10,79). Os indicadores de complexidade de assistência foram de fato mais freqüentes no grupo de near miss, que também apresentou número menor de casos com hipertensão (30% contra 62,5%) e maior com hemorragia (35,5% contra 10,6%) como fatores determinantes primários de morbidade grave. CONCLUSÕES: a maior gravidade da morbidade materna associou-se ao antecedente de aborto e à hemorragia como causa. O escore aplicado conseguiu identificar um subgrupo de maior gravidade (near miss) e que demanda atendimento profissional e institucional mais complexo para evitar a ocorrência do óbito.

Fatores determinantes do near miss materno em uma unidade de terapia intensiva obstétrica

OBJETIVO:Avaliar os fatores determinantes da morbimortalidade em unidade de terapia intensiva obstétrica de um hospital universitário.MÉTODOS:Estudo observacional de corte transversal com 492 gestantes ou puérperas. Foram selecionadas pacientes internadas na unidade de terapia intensiva obstétrica no período de um ano, sendo informadas sobre as propostas do estudo e realizada aplicação do questionário. A análise foi feita através do Microsoft Excel 2013 e GraphPad Prism 6. Foram empregados testes do χ2 para verificar associação entre os fatores de risco para morbimortalidade materna grave.RESULTADOS: Foram encontrados como riscos relativos significativamente elevados para desenvolvimento de near missquando comparada à morbidade materna grave, a raça não branca (OR=2,5; RP=2,3); pacientes casadas (OR=7,9; RP=7,1), escolaridade até 2º grau incompleto (OR=3,1; RP=2,8), procedente do interior (OR=4,6; RP=4,0), renda familiar menor que 1 salário mínimo (OR=7,0; RP=5,5), distúrbios hipertensivos gestacionais (OR=16,3; RP=13,2), realização do pré-natal (OR=5,0; RP=4,2) e a via de parto cesárea (OR=39,2; RP=31,2).CONCLUSÕES: Questões socioeconômicas, clínicas e assistenciais mostraram-se relacionados à prevalência de near miss, revelando a importância de intervenções amplas para melhorar esses indicadores. Reforça-se a importância da realização de pré-natal para identificação de riscos potenciais, garantia de um suporte nutricional à gestante, tratamento de doenças e estabelecimento de programa de imunização materna, assim como uma melhor assistência no que tange aos aspectos clínicos das pacientes, objetivando diminuir o risco obstétrico e neonatal.

Normal median near nerve potential

In routine studies of sensory nerve conduction, only fibers e7 µm in diameter are analyzed. The late components which originate from thinner fibers are not detected. This explains why a normal sensory action potential (SAP) may be recorded in patients with peripheral neuropathies and sensory loss. In the present study we investigated the late component of the median SAP with a near nerve needle electrode technique in 14 normal volunteers (7 men and 7 women), aged 34.5 ± 14.8 years. The stimulus consisted of rectangular pulses of 0.2-ms duration at a frequency of 1 Hz with an intensity at least 6 times greater than the threshold value for the main component. Five hundred to 2000 sweep averagings were performed. The duration of analysis was 40 or 50 ms and the wave analysis frequency was 200 (-6 dB/oct) to 3000 Hz (-12 dB/oct). We used an apparatus with a two-channel amplifier system, 200 MW or more of entry impedance and a noise level of 0.7 µVrms or less. The main component mean amplitude, conduction velocity and latency and the late component mean amplitude, conduction velocity and latency were respectively (mean ± SD): 26.5 ± 5.42 µV, 56.8 ± 5.42 m/s, 3.01 ± 0.31 ms, 0.12 ± 0.04 µV, 16.4 ± 2.95 m/s and 10.6 ± 2.48 ms. More sophisticated equipment has an internal noise of 0.6 µVrms. These data demonstrate that the technique can now be employed to study thin fiber neuropathies, like in leprosy, using commercial electromyographs, even in non-academic practices