Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department

Background Occupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed. Goal To evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method. Methods A group of patients in need of respiratory isolation were first identified-group I (2004; 29 patients; 44.1 +/- 3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year-group II (2007; 50 patients; 43.4 +/- 1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained. Results Implementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5 +/- 9.3 X 3.7 +/- 2.0; p = 0.0180) and from indication to effective respiratory isolation (13.3 +/- 3.0 X 2.94 +/- 1.06; p = 0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 X 75.4/100.000 patients; p < 0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p < 0.001 greater for 2007. Conclusion Implementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

Haida Totem Poles: Reflections of a Society

The Haida were a First Nations group located on the Northwest Coast of Canada. They were exceptional wood carvers that produced various types of works, the most monumental of which were their totem poles. This dissertation analyses 26 of these open architectural structures, each of which belonged to one of the following five types: frontal, mortuary, memorial, house post, or corner post. Of the representations found on poles, 28 different figures were identified. However, individual poles were found to contain between one and fourteen different figures with frontal poles generally featuring the most. The predominant figures on the inventoried poles proved to be birds, humans, and bears. An iconographic structure of a tripartite character was detected that reflects the religious ideology of the Haida population with birds being featured at the top of the poles, humans in the middle, and bears at the lowest point. It also suggests the possible transition from a hunter-gatherer economy to a food producing economy.***********************************************************************************Os Haida foram um grupo das Primeiras Nações que habitaram a costa Noroeste do Canadá. Eram excepcionais escultores de madeira, tendo produzido variados tipos de artefactos, dos quais os totem poles eram os mais monumentais. Na presente dissertação são analisadas 26 dessas estruturas arquitectónicas de exterior, sendo que cada uma delas pertenceria a um dos seguintes cinco tipos: frontal, funerário, memorial, travemestra, ou postes de esquina. Das representações encontradas nos postes, foram individualizadas 28 figuras. No entanto, em postes isolados foi possível identificar entre uma e catorze figuras distintas, sendo os postes frontais os que apresentavam, geralmente, o maior número. A análise destes postes permitiu detectar uma estrutura iconográfica tripartida que reflectia a ideologia religiosa das populações Haida, representando-se as aves no topo, os humanos a meio, e os ursos na base dos postes. Por outro lado, foi possível sugerir, para estas populações, a transição de uma economia baseada na caça-recolecção para uma economia de produção alimentar.

Surgical outcomes following repeat non-penetrating glaucoma filtration surgery at a tertiary referral centre

Purpose:To determine the surgical outcomes of patients undergoing repeat deep sclerectomies with collagen implant (DSCI) at a tertiary referral centre. Methods:The medical notes of 208 patients undergoing multiple DSCI were reviewed. Those undergoing repeat DSCI were identified and post operative data for each DSCI were analysed. Group A: the first DSCI; group B: second DSCI; group C: third DSCI. Results:Mean age was 66.8 ±13.0 years. At 12 months, percentage of mean IOP reduction in groups were 18%, 24% and 17% respectively. Mean interval to starting glaucoma medications, re-operation, mitomycin injection and goniopuncture all decreased as the number of operations increased. There was a significant reduction in complete success rates between groups A and B and groups B and C. Few minor complications were observed in all 3 groups. Conclusions:Despite the possibility of bleb independent outflow pathways in patients undergoing non-penetrating surgery, there are significantly reduced success rates in eyes undergoing repeat DSCI. This has important implications for the choice of subsequent operations in patients who have failed non-penetrating filtration surgery.

Single cell analysis reveals similar functional competence of dominant and nondominant CD8 T-cell clonotypes.

Immune protection from infectious diseases and cancer is mediated by individual T cells of different clonal origin. Their functions are tightly regulated but not yet fully characterized. Understanding the contribution of each T cell will improve the prediction of immune protection based on laboratory assessment of T-cell responses. Here we developed techniques for simultaneous molecular and functional assessment of single CD8 T cells directly ex vivo. We studied two groups of patients with melanoma after vaccination with two closely related tumor antigenic peptides. Vaccination induced T cells with strong memory and effector functions, as found in virtually all T cells of the first patient group, and fractions of T cells in the second group. Interestingly, high functionality was not restricted to dominant clonotypes. Rather, dominant and nondominant clonotypes acquired equal functional competence. In parallel, this was also found for EBV- and CMV-specific T cells. Thus, the nondominant clonotypes may contribute similarly to immunity as their dominant counterparts.

China´s Economic Security Police Towards ASEAN From

After the economic reforms of 1978, China started rising very fast and started engaging other countries in the region which has served to increase its confidence in the region. In the post cold war period, China was seen as a big threat for the region because of its claims on the South China Sea. Nevertheless, this image was eliminated when China engaged ASEAN and other multilateral and regional organizations. This paper is studying China’s economic and security policies towards ASEAN. Globalization Theory is the theory being used to explain the nature of China-ASEAN relations. This research paper argues that China’s rise is promoting peace in the region. With the engagement policy, China started promoting trade and security co operations based on mutual benefits and dialogues for the peaceful resolutions of the disputes in the region. This contributed greatly to improve China’s image in the region. Additionally, China’s posture during the economic crises of 1997 also greatly contributed to improve its image. Thus, the rise of China is providing opportunity to the other countries in East Asia. Chapter One: Background On China-ASEAN Relations The use of Soft Power and engagement policy by the Chinese government has helped to change China’s image in the region. By using these policies China has been able to clear the feeling of suspicion and mistrust among the Asian states. China has increased its participation in multilateral and regional organizations, such as ASEAN. Due to this China has been able to promote economic and security co-operation among countries in the region. Thus, from being a potential threat China became a potential co-operative partner. Chapter Two: A Look into ASEAN ASEAN was originally formed on 8th August 1967 in Bangkok, Thailand, by Indonesia, Malaysia, the Philippines, Singapore and Thailand. Nevertheless, ASEAN was not the first regional group created to act as forum for dialogue between the leaders of different countries. Thought, it is the only one which could work in the region. The aim of the foundation of ASEAN was to promote peace and stability in the Abstract 2 region and also contain the spread of communism in Southeast Asia. For this reason, China did not engage ASEAN until 1990. However, in 1978 with the establishment of the open up policy China started engaging other countries. It started building trust among its neighboring countries by using soft power. By 1992, China formalized its diplomatic ties with ASEAN as a group. The diplomatic ties between China and ASEAN focus on multilateralism and co-operation as the best way for a more peaceful Asia and the search for common security. Thus, security in the region is promoted through economic co-operation among the states. Therefore the relation between China – ASEAN emphasizes the five principles of peaceful coexistence, mutual benefits in economic co-operation, dialogue promoting trust and the peaceful settlement of disputes. Chapter Three: China-ASEAN Economic Relations Since 1978 The economic reform of 1978 has greatly contributed to the economic development of China. After the adoption of the open up policy, China has been able to establish economic and trade relations with the outside world. The realist school of thought had predicted that Asia will not be stable in the post cold war period. Nevertheless, this has not been the case in Asia. China is growing peacefully with the co-operation of countries in the region. China is establishing strong ties with its neighboring countries. China and ASEAN relations focus on mutual benefit instead of being a zero sum game. Thus these relations are aimed at encouraging trust and economic co-operation in the region. China and ASEAN have agreed on Free Trade to assure that the two parties benefit from the co-operation. The ACFTA will have a great impact on economic, political and security issues. This will enable China to increase its influence in Asia and counterbalance the influences that Japan and U.S have in the region. Chapter Four: China ASEAN Relations in the Security Perspective This Chapter is about China and ASEAN relations on security issue. The new security issues of the post cold war period need to be solved in multilateral way. China as a major power in the region, through its engagement policy has solved most Abstract 3 of the disputes in the region using multilateral means. China has also found ways to solve the dispute over Spratly Islands peacefully, through dialogue using ASEAN. Additionally, China signed the Treaty of Amity in 2003, promoted security initiatives through ARF, Declaration on Conduct of Parties in the South China Sea and documents covering non-traditional security threats, economic co-operation and agricultural co-operation in November 2002, and the Joint Declaration on Strategic. Chapter Five: Finding and Analysis This chapter provides a quantitative and qualitative analysis of the date collected throughout this research. It provides an analysis of how the rise of China is promoting peace in the region. China has been promoting mutual beneficial trade and security co-operation which has increased its influence in the region. China has also been able to solve most of the territorial and border dispute in the region through ASEAN. Thus, ASEAN has amended China’s relations with other countries in the region. Therefore, China’s foreign policy in the region has a big impact in shaping the dynamic relations in East Asia. Conclusion and Recommendations This paper concluded that the relationships between China and ASEAN are contributing to peace in the region. After China engaged ASEAN, it has been able to promote multilateral trade based on mutual benefit. This is clearly emphasized by the CAFTA. Additionally, China has solved most of the dispute in the region. It has also found way for a peaceful resolution of the dispute over Spratly Island. Nowadays, the ASEAN countries don’t see China as a threat to the region. Nevertheless, they’ve adopted deterrence measures such as establishing diplomatic relations with other big powers in the region to assure that the region continues to grow peacefully. Concerning this deterrence measures, I recommend as another way for a continued peaceful growth, the resolution of the outstanding dispute.

Fluoroscopic-Guided Radial Endobronchial Ultrasound Without Guide Sheath For Peripheral Pulmonary Lesions: A Safe And Efficient Combination.

BACKGROUND: Several guidelines recommend computed tomography scans for populations with high-risk for lung cancer. The number of individuals evaluated for peripheral pulmonary lesions (PPL) will probably increase, and with it non-surgical biopsies. Associating a guidance method with a target confirmation technique has been shown to achieve the highest diagnostic yield, but the utility of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance without a guide sheath has not been reported. METHODS: We conducted a retrospective analysis of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy procedures for the investigation of PPL performed by experienced bronchoscopists with no specific previous training in this particular technique. Operator learning curves and radiological predictors were assessed for all consecutive patients examined during the first year of application of the technique. RESULTS: Fifty-one PPL were investigated. Diagnostic yield and visualization yield were 72.5 and 82.3% respectively. The diagnostic yield was 64.0% for PPL ≤20mm, and 80.8% for PPL>20mm. No false-positive results were recorded. The learning curve of all diagnostic tools showed a DY of 72.7% for the first sub-group of patients, 81.8% for the second, 72.7% for the third, and 81.8% for the last. CONCLUSION: Bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance is safe and simple to perform, even without specific prior training, and diagnostic yield is high for PPL>and ≤20mm. Based on these findings, this method could be introduced as a first-line procedure for the investigation of PPL, particularly in centers with limited resources.

When decisions of others matter to me: an electrophysiological analysis.

Background: Actions of others may have immediate consequences for oneself. We probed the neural responses associated with the observation of another person"s action using event-related potentials in a modified gambling task. In this task a"performer" bet either a higher or lower number and could win or lose this amount. Three different groups of"observers" were also studied. The first (neutral) group simply observed the performer"s action, which had no consequences for the observers. In the second (parallel) group, wins/losses of the performer were paralleled by similar wins and losses by the observer. In the third (reverse) group, wins of the performer led to a loss of the observer and vice versa. Results: ERPs of the performers showed a mediofrontal feedback related negativity (FRN) to losses. The neutral and parallel observer groups did similarly show an FRN response to the performer"s losses with a topography indistinguishable from that seen in the performers. In the reverse group, however, the FRN occurred for wins of the performer which translated to losses for the observer. Conclusions: Taking into account previous experiments, we suggest that the FRN response in observers is driven by two evaluative processes (a) related to the benefit/loss for oneself and (b) related to the benefit/loss of another person

Comparative study between patients with acute appendicitis treated in primary care units and in emergency hospitals

Objective: To retrospectively analyze the relationship of time of care, combined with possible post-appendectomy complications, with the promptness of transfer of patients seen in Emergency Care Units (UPA) to the emergency hospital.Methods: We analyzed patients with preoperative diagnosis of acute appendicitis undergoing appendectomy from January to July 2012. Patients were divided into two groups according to the site of the first care. Group A included patients who received initial care directly in the emergency department of the Lourenço Jorge County Hospital (HMLJ) and group B consisted of patients seen in the UPA and forwarded to HMLJ to undergo surgical treatment.Results: the average time between initial treatment and surgery in group A was 29 hours (SD = 21.95) and 54 hours in group B (SD = 54.5). Considering the onset of symptoms, the patients in group A were operated on average 67 hours after (SD = 42.55), while group B, 90 hours (SD = 59.58). After the operation, patients in group A were hospitalized, on average, for 94 hours (SD = 73.53) and group B, 129 hours (SD = 193.42).Conclusion: there was no significant difference in the time elapsed between the onset of symptoms, initial treatment and early surgical treatment, or time elapsed between surgery and discharge.

Collaborative information behaviour : a case study of two research groups

The aim of the licentiate thesis is to examine researchers' information practices in research groups. The researchers were involved with study communication and media related issues within Social Sciences and Humanities Faculties. The theoretical framework of the study comprises the new holistic models of information seeking (for example: Meho and Tibbo, 2003; Seldén, 1999) and the collective aspects of information behaviour (Prekop, 2002 ; Talja, 2002; Talja and Hansen, 2006). The research questions are: 1. How do scholars seek information in research groups? 2 What kind of collaborative information behaviour occurs in the research groups? The research data was gathered by interviews and observations. Three meetings of a research group at the University of Tampere were observed during the autumn of 2004. The group members and the group leader of the research group were interviewed in the spring of 2005. The research group members and the group leader of a research group at the University of Jyväskylä were interviewed in the autumn of 2005. Altogether, two research group leaders and eight researchers were interviewed. The significance of the research group for information seeking is more important in closeknit research groups than in rather loose research groups. The significance of the research group for information seeking can be at least threefold. First, research group members can inform the group about relevant information resources and potential library or other information services. Second, the research group can to some extent compensate for the information seeking systems of libraries by distributing material and information resources. Third, information seeking can be carried out in collaboration in research groups. The significance of the research group was found to be most important in informing about new information services and marketing library systems. Recommendations from colleagues were often needed to mobilize researchers into using new library services. The significance of colleagues in informing about library services is in line with earlier studies. The present study showed that sometimes information from colleagues was regarded as more important than information distributed directly by the local library. A culture of information sharing, including mutual trust, seemed mainly to be reflected in collaboration and collaborative information seeking in the research groups studied. The timing of the onset of individual research seemed to be related to the information sharing culture and social networks in research groups. The simultaneous onset of the research work by group members seemed to promote the growth of unbiased collaboration, also in information seeking.

A comparative analysis of preprocessing techniques of cardiac event series for the study of heart rhythm variability using simulated signals

In the present study, using noise-free simulated signals, we performed a comparative examination of several preprocessing techniques that are used to transform the cardiac event series in a regularly sampled time series, appropriate for spectral analysis of heart rhythm variability (HRV). First, a group of noise-free simulated point event series, which represents a time series of heartbeats, was generated by an integral pulse frequency modulation model. In order to evaluate the performance of the preprocessing methods, the differences between the spectra of the preprocessed simulated signals and the true spectrum (spectrum of the model input modulating signals) were surveyed by visual analysis and by contrasting merit indices. It is desired that estimated spectra match the true spectrum as close as possible, showing a minimum of harmonic components and other artifacts. The merit indices proposed to quantify these mismatches were the leakage rate, defined as a measure of leakage components (located outside some narrow windows centered at frequencies of model input modulating signals) with respect to the whole spectral components, and the numbers of leakage components with amplitudes greater than 1%, 5% and 10% of the total spectral components. Our data, obtained from a noise-free simulation, indicate that the utilization of heart rate values instead of heart period values in the derivation of signals representative of heart rhythm results in more accurate spectra. Furthermore, our data support the efficiency of the widely used preprocessing technique based on the convolution of inverse interval function values with a rectangular window, and suggest the preprocessing technique based on a cubic polynomial interpolation of inverse interval function values and succeeding spectral analysis as another efficient and fast method for the analysis of HRV signals

Prodrug strategies of antiviral nucleotides: Studies on enzymatically and thermally removable phosphate protecting groups

Antiviral nucleosides are compounds that are used against viruses, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV). To act as therapeutic agent, the antiviral nucleoside needs to be phosphorylated to nucleotide in the body in three consecutive phosphorylation steps by cellular or viral enzymes. The first phosphorylation to the nucleoside monophosphate is often inefficient and leads to poor antiviral activity. The antiviral efficacy can be improved by applying a prodrug strategy and delivering the antiviral nucleoside directly as its monophosphate. In prodrug strategies of antiviral nucleotides, the negative charges on the phosphate moiety are temporarily masked with protecting groups. Once inside the cell, the protecting groups are removed by enzymatic or chemical processes. Many prodrug strategies apply biodegradable protecting groups, the removal of which is triggered by esterase enzymes. Several studies have, however, demonstrated that the removal rate of the second and subsequent esterase labile protecting groups significantly slows down after the first protecting group is removed due to the negative charge on the phosphodiester intermediate, which disturbs the catalytic site of the enzyme. In this thesis, esterase labile protecting group strategies where the issue of retardation could be avoided were studied. Prodrug candidates of antiviral nucleotides were synthesized and kinetic studies on the chemical and enzymatic stability were carried out. In the synthesized compounds, the second protecting group is cleaved from the monophosphate some other mechanism than esterase triggered activation or the structure of prodrug requires only one protecting group. In addition, esterase labile protecting group which is additionally thermally removable was studied. This protecting group was cleaved from oligomeric phosphodiesters both enzymatically and thermally and seems most attractive of the studied phosphate protecting groups. However, the rate of the thermal removal still is too slow to allow efficient protection of longer oligonucleotides and needs optimization. Key words: antiviral, nucleotide, prodrug, protecting group, biodegradable

Towards a Skills Audit: identifying your experience

A workshop session which looks at skills from an employers perspective. Slides plus link to Graduate Recruiters Association. Used in first small group class of info1010 - covers ground rules, career destinations, typical earnings,types of jobs and skills evaluation. Slides are reference for interactive discussions

On cohomologies and extensions of cyclic groups

Cohomology groups H(s)(Z(n), Z(m)) are studied to describe all groups up to isomorphism which are (central) extensions of the cyclic group Z(n) by the Z(n)-module Z(m). Further, for each such a group the number of non-equivalent extensions is determined. (C) 2011 Elsevier B.V. All rights reserved.

Automorphism Groups of Generalized (Binary) Icosahedral, Tetrahedral and Octahedral Groups

Let G be any of the (binary) icosahedral, generalized octahedral (tetrahedral) groups or their quotients by the center. We calculate the automorphism group Aut(G).

Trajetos cênicos do grupo parafolclórico da UFRN:que dança é essa?

This paper aims at studying UFRN Parafolclórico Group, whose aesthetic formation is subjected to our analysis, specially at its two last performances, that is, Flor do Lírio (Lily Flower), 2004, and Debaixo do Barro do Chão (Under the Mud of the Ground), 2008. Three targets are envisaged here: to analyze the aesthetic ideas backing Parafolclórico Group exhibitions; to evaluate how their many folk elements interact with different artist languages in order to compose a certain choreography; and finally, to identify the aesthetic conformation placed behind the two different choreographs of the last performances, their trends and innermost features that differentiate them. In accordance with the Analysis of Contents (BARDIN, 2006), interviews have been made with the choreographers and the staff of the spectacles, resulting in elucidating answers to the understanding of their thematic axis. On the first chapter we called attention to motivating subjects as recollection, personal experiences, bibliography research, research in loco regarded as propelling forces of the creative works. Herein, folk culture is depicted as a dynamic process opening a frank dialogue with contemporary events and reinforcing their continuity. On the second chapter, we approached the aesthetic conformation and the scenic elements (costumes, light, scenario, make-up), integrating the studied spectacles and disseminating folk songs in various ways. As what concerns the subjects discourse, we have obtained support in authors like Robatto (1994); Lobo; Navas (2008); Burke (1989); Canclini (2006); Dufrenne (2005); Medeiros (2005); Pavis (2005); Silva (2005), among others. Those authors have provided us with an indispensable theoretic support which, added to the interviews, convinced us that the Parafolclórico Group s aesthetic conception tends to identify itself with the artist languages and other techniques of that Group. It also made sure that the Group s course aims at an aesthetic conception which is not limited to popular culture manifestations, like dance, but admits to play with other media in order to communicate its art. In view of this situation, we arrived to two conclusions: first: the group s interchanges emphasize the dynamic character of popular culture which, by establishing contacts with different realities, receives influences capable of extending its own continuity; second: the contemporary state of arts also improves multiple interchanges opening way, so, for many accomplishments in their field. Therefore, UFRN Parafolclórico Group inserts itself in the contemporary scenery by performing new evaluations of the popular dances as long as it puts them in contact with different technical, aesthetic, artist and culture combinations