Living benthic foraminifers from the central Arctic Ocean

Fifty short sediment cores collected with a multiple corer and five box cores from the central Arctic Ocean were analysed to study the ecology and distribution of benthic foraminifers. To work out living faunal associations, standing stock and diversity, separate analyses of living (Rose Bengal stained) and dead foraminifers were carried out for the sediment surface. The size fractions between 63 and 125 µm and >125 µm were counted separately to allow comparison with former Arctic studies and with studies from the adjacent Norwegian-Greenland Sea, Barents Sea and the North Atlantic Ocean. Benthic foraminiferal associations are mainly controlled by the availability of food, and competition for food, while water mass characteristics, bottom current activity, substrate composition, and water depth are of minor importance. Off Spitsbergen in seasonally ice-free areas, high primary production rates are reflected by high standing stocks, high diversities, and foraminiferal associations (>125 µm) that are similar to those of the Norwegian-Greenland Sea. Generally, in seasonally ice-free areas standing stock and diversity increase with increasing food supply. In the central Arctic Ocean, the oligotrophic permanently ice-covered areas are dominated by epibenthic species. The limited food availability is reflected by very low standing stocks and low diversities. Most of these foraminiferal associations do not correspond to those of the Norwegian-Greenland Sea. The dominant associations include simple agglutinated species such as Sorosphaerae, Placopsilinellae, Komokiacea and Aschemonellae, as well as small calcareous species such as Stetsonia horvathi and Epistominella arctica. Those of the foraminiferal species that usually thrive under seasonally ice-free conditions in middle bathyal to lower bathyal water depth are found under permanently ice-covered conditions in water depths about 1000 m shallower, if present at all.

Distribution of heavy minerals in sediment cores from the Laptev Sea continental margin and the central Arctic Ocean

Focussing on heavy-mineral associations in the Laptev-Sea continental margin area and the eastern Arctic Ocean, 129 surface sediment samples, two short and four long gravity cores have been studied. By means of the accessory components, heavy-mineral associations of surface sediment samples from the Laptev-See continental slope allowed the distinction into two different mineralogical provinces, each influenced by fluvial input of the Siberian river Systems. Transport pathways via sea ice from the shallow shelf areas into the Arctic Ocean up to the final ablation areas of the Fram Strait can be reconstructed by heavy-mineral data of surface sediments from the central Arctic Ocean. The shallow shelf of the Laptev Sea seems to be the most important source area for terrigenous material, as indicated by the abundant occurence of amphiboles and clinopyroxenes. Underneath the mixing Zone of the two dominating surface circulation Systems, the Beaufort- Gyre and Transpolar-Drift system, the imprint of the Amerasian shelf regions up to the Fram Strait is detectable because of a characteristical heavy-mineral association dominated by detrital carbonate and opaque minerals. Based On heavy-mineral characteristics of the potential circum-Arctic source areas, sea-ice drift, origin and distribution of ice-rafted material can be reconstructed during the past climatic cycles. Different factors controlling the transport of terrigenous material into the Arctic Ocean. The entrainment of particulate matter is triggered by the sea level, which flooded during highs and lows different regions resulting in the incorporation of sediment from different source areas into the sea ice. Additionally, the fluvial input even at low stands of sea level is responsible for the delivery of material of distinct sources for entrainment into the sea ice. Glacials and interglacials of climate cycles of the last 780 000 years left a characteristical signal in the central Arctic Ocean sediments caused by the ice- rafted material from different sources in the circum-Arctic regions and its change through time. Changes in the heavy-mineral association from an amphibole-dominated into a garnet-epidote-assemblage can be related to climate-related changes in source areas and directions of geostrophic winds, the dominating drive of the sea-ice drift. During Marine Isotope Stage (MIS) 6, the central Arctic Ocean is marked by an heavy-mineral signal, which occurs in recent sediments of the eastern Kara Sea. Its characteristics are high amounts of epidote, garnet and apatite. On the other hand, during the Same time interval a continuous record of Laptev Sea sediments is documented with high contents of amphiboles on the Lomonosov Ridge near the Laptev Sea continental slope. A nearly similar Pattern was detected in MIS 5 and 4. Small-scale glaciations in the Putorana-mountains and the Anabar-shield may have caused changes in the drainage area of the rivers and therefore a change in fluvial input. During MIS 3, the heavy-mineral association of central Arctic sediments show similar patterns than the Holocene mineral assemblage which consists of amphiboles, ortho- and clinopyroxenes with a Laptev Sea source. These minerals are indicating a stable Transpolar-Drift system similar to recent conditions. An extended influence of the Beaufort Gyre is only recognized, when sediment material from the Amerasian shelf areas reached the core location PS2757-718 during Termination Ib. Based On heavy-mineral data from Laptev-Sea continental slope Core PS2458-4 the paleo-sea-ice drift in the Laptev Sea during 14.000 years was reconstructed. During Holocene sea-level rise, the bathymetrically deeper parts of the Western shelf were flooded first. At the beginning of the Atlantic stage, nearly the entire shelf was marine influenced by fully marine conditions and the recent surface circulation was established.

Broad-scale patterns of sex ratios in Patella spp.: a comparison of range edge and central range populations in the British Isles and Portugal

Sex change, or sequential hermaphroditism, occurs in the plant and animal kingdoms and often determines a predominance of the first sex. Our aim was to explore changes in sex ratios within the range of the species studied: Patella vulgata and Patella depressa. The broad-scale survey of sex with size of limpets covered a range of latitudes from Zambujeira do Mar (southern Portugal) to the English Channel. Indirect evidence was found for the occurrence of protandry in P. vulgata populations from the south of England, with females predominating in larger size-classes; cumulative frequency distributions of males and females were different; sex ratios were biased towards males and smallest sizes of males were smaller than the smallest sizes of females. In contrast in Portugal females were found in most size-classes of P. vulgata. In P. depressa populations from the south coast of England and Portugal females were interspersed across most size-classes; size distributions of males and females and size at first maturity of males and females did not differ. P. depressa did, however, show some indications of the possibility of slight protandry occurring in Portugal. The test of sex ratio variation with latitude indicated that P. vulgata sex ratios might be involved in determining the species range limit, particularly at the equatorward limit since the likelihood of being male decreased from the south coast of England to southern Portugal. Thus at the southern range limit, sperm could be in short supply due to scarcity of males contributing to an Allee effect.

Broad-scale patterns of sex ratios in Patella spp.: a comparison of range edge and central range populations in the British Isles and Portugal

Sex change, or sequential hermaphroditism, occurs in the plant and animal kingdoms and often determines a predominance of the first sex. Our aim was to explore changes in sex ratios within the range of the species studied: Patella vulgata and Patella depressa. The broad-scale survey of sex with size of limpets covered a range of latitudes from Zambujeira do Mar (southern Portugal) to the English Channel. Indirect evidence was found for the occurrence of protandry in P. vulgata populations from the south of England, with females predominating in larger size-classes; cumulative frequency distributions of males and females were different; sex ratios were biased towards males and smallest sizes of males were smaller than the smallest sizes of females. In contrast in Portugal females were found in most size-classes of P. vulgata. In P. depressa populations from the south coast of England and Portugal females were interspersed across most size-classes; size distributions of males and females and size at first maturity of males and females did not differ. P. depressa did, however, show some indications of the possibility of slight protandry occurring in Portugal. The test of sex ratio variation with latitude indicated that P. vulgata sex ratios might be involved in determining the species range limit, particularly at the equatorward limit since the likelihood of being male decreased from the south coast of England to southern Portugal. Thus at the southern range limit, sperm could be in short supply due to scarcity of males contributing to an Allee effect.

Implementação de um plano de segurança de águas num hospital

Dissertação de Natureza Científica para obtenção do grau de Mestre em Engenharia Civil

Stay-green Drought Adaptation Trait Enhances Sorghum Production in Sub-tropical Australia, Central-Western India and Sub-Saharan Africa

Drought during grain filling is a common challenge for sorghum production in north-eastern Australia, central-western India, and sub-Saharan Africa. We show that the stay-green drought adaptation trait enhances sorghum grain yield under post-anthesis drought in these three regions. A positive relationship between stay-green and yield was generally found in breeding trials in north-eastern Australia that sampled 1668 unique hybrid combinations and 23 environments. Physiological studies in Australia also found that introgressing four individual stay-green (Stg1–4) quantitative trait loci (QTLs) into a senescent background reduced water demand before flowering and hence increased water supply during grain filling, resulting in higher grain yield relative to the senescent control. Studies in India found that various Stg QTLs affected both transpiration and transpiration efficiency, although these effects depended on the interaction between genetic background (S35 and R16) and individual QTLs. The yield variation unexplained by harvest index was related to transpiration efficiency in S35 (R2 = 0.29) and R16 (R2 = 0.72), and was related to total water extracted in S35 (R2 = 0.41) but not in R16. Finally, sixty-eight stay-green enriched lines were evaluated in six countries in sub-Saharan Africa during the 2013/14 season. Analysis of the data from Kenya indicates that stay-green and grain size were positively correlated at two sites: Kiboko (high yielding, r2=0.25) and Masongaleni (low yielding, r2=0.37). Together, these studies suggest that stay-green is a beneficial trait for sorghum production in the semi-arid tropics and is a consequence of traits altering the plant water budget.

Cuidar do doente com pacemaker transvenoso provisório: a realidade no Hospital Prof Dr Fernando Fonseca

O trabalho tem como objetivos perceber, desde 27 de abril de 2014 a 31 de Dezembro de 2014, quantas pessoas colocaram pacemaker provisório no Hospital Professor Doutor Fernando Fonseca, o número de dias que, em média, uma pessoa permaneceu com pacemaker provisório antes da implantação de um Pacemaker definitivo, a revisão da bibliografia dos cuidados de enfermagem na colocação e manutenção do pacemaker provisório e finalmente, a realização de um procedimento sobre os cuidados de enfermagem a ter com a pessoa com pacemaker provisório. Durante o espaço temporal estudado foram colocados pacemakers provisórios a 62 pessoas, tendo sido necessário implantar pacemaker definitivo a 41 dessas pessoas (66%) tendo sido esta a população alvo da pesquisa. Analisando a população alvo percebemos que cada pessoa teve em média 4,37 dias o pacemaker provisório, sendo que algumas implantaram o pacemaker definitivo no próprio dia enquanto que uma pessoa teve o pacemaker provisório 17 dias. A média de idades da população alvo era de 75 anos, com variância entre os 53 anos e os 92 anos. Os locais escolhidos para a colocação do pacemaker provisório foram as veias femoral e jugular, não tendo havido nenhum caso em que a via de acesso tenha sido a veia subclávia. O grande número de dias em que algumas pessoas permaneceram com o pacemaker provisório, a idade avançada de parte da população considerada, o facto de algumas das pessoas com pacemaker provisório não estarem internados no serviço de Cardiologia e os estudos e relatórios que consideram as infeções nosocomiais da corrente sanguínea como uma das infeções associadas aos cuidados de saúde que mais contribuí para a morbilidade e mortalidade nos hospitais, referindo ainda que um dos dois fatores extrínsecos mais significativos para o aparecimento de infeções nosocomiais da corrente sanguínea foi a existência de um cateter venoso central. Considerei que todos estes dados justificam a revisão da literatura atual existente sobre os cuidados de enfermagem durante a colocação e manutenção de um pacemaker provisório e a realização de um procedimento sobre a manutenção dos pacemakeres provisórios a ser aplicado transversalmente no Hospital Professor Doutor Fernando Fonseca.

Factores de riesgo en primera crisis convulsiva en menores de 16 años: Hospital Vicente Corral Moscoso 2000-2001

Con el objetivo de determimar los factores de riesgode la primera crisis epiléptica en menores de 16 años, se realiza el estudio de caso-control, a un universo de niños de 0-16 años, atendidos en el hospital Vicente Corral Moscoso entre octubre 2000 a septiembre de 2001, con primera crisis epiléptica. Controles, por cada 2 niños de igual edad y sexo sin crisis y sin patología neurológica. Recolección de la información: mediante un formulario con información proporcionada por el niño, acompañantes y la que consta en la historia clíonica. La categorización de las crisis se realizó de acuerdo a la recomendación de la Comisión sobre Clasificación y Terminología de la Liga Internacional contra la Epilepsia. Resultados: se encuentra 143 casos. Varones 59.4, mujeres 40.6. Menores de 5 años 81. Con crisis generalizadas 65, de origen sintomático agudo (78.3). Las principales causas fueron: fiebre, infecciones del sistema nervioso central, hipoxia, trauma encefalocraneano, trastornos metabólicos y tóxicos. Los factores de riesgo (estadísticamente significativos, p menor que 0.05) son: asfixia perinatal, parto atendido por empírico, recién nacido pequeño para la edad gestacional, malformación congénira, anormalidad de actividades diarias y desarrollo psicomotor, desnutrición, espasmo del sollozo, antecedentes personales de crisis febriles, antecedentes familiares de crisis afebril única, antecedentes de epilepsia en familiares que no pertenecen al primer grado de consanguinidad. Conclusiones. La primera crisis epiléptica fue más frecuente en varones, menores de 5 años, con crisis generalizadas , de origen sintomático agudo y los factores de riesgo estuvieron relacionados a aspectos pre-perinatales, anormalidad de la actividad diaria y del desarrollo psicomotor, desnutrición, episodios paroxísticos personales y antecedentes convulsivos familiares

Regional differences of outpatient physician supply as a theoretical economic and empirical generalized linear model

BACKGROUND: Regional differences in physician supply can be found in many health care systems, regardless of their organizational and financial structure. A theoretical model is developed for the physicians' decision on office allocation, covering demand-side factors and a consumption time function. METHODS: To test the propositions following the theoretical model, generalized linear models were estimated to explain differences in 412 German districts. Various factors found in the literature were included to control for physicians' regional preferences. RESULTS: Evidence in favor of the first three propositions of the theoretical model could be found. Specialists show a stronger association to higher populated districts than GPs. Although indicators for regional preferences are significantly correlated with physician density, their coefficients are not as high as population density. CONCLUSIONS: If regional disparities should be addressed by political actions, the focus should be to counteract those parameters representing physicians' preferences in over- and undersupplied regions.

Social representations of nursing students about hospital assistance and primary health care

Objective: To analyze how social representations of hospital and community care are structured in two groups of nursing students – 1st and 4th years. Method: Qualitative research oriented by the Theory of Social Representations. We used a questionnaire with Free Association of Words. Data were analyzed in the Software IRaMuTeQ 0.6 alpha 3. Results: We applied the method of Descending Hierarchical Classifi cation and obtained four classes. Class 4 has the largest social representation (30.41%) within the corpus. The two organizational axes are nurse and disease/patient in the central core. On the periphery are the care and help related to the nurse and the treatment and prevention associated with the disease. Conclusion: Social representations focus on disease/patient and on the role of nurses in the treatment, prevention, and care. Health promotion and the social determinants of health are absent from the social representations of students.

Perfil epidemiológico, evolución clínica, complicaciones y correlación histopatológica de pacientes que consultan en la unidad de emergencia del Hospital Nacional Especializado de Maternidad con diagnóstico de aborto. Enero-Diciembre, 2013

El presente estudio desarrollado en el Hospital Nacional Especializado de Maternidad, inaugurado oficialmente en diciembre 1953, y que comenzó a dar servicio el 20 de abril de 1954, considerado dentro de la red nacional de hospitales, como centro de tercer nivel por el grado de complejidad de servicios ofertados. El objeto de estudio que servirá de base es la embarazada que consulta la unidad de emergencia y que finaliza el embarazo en un aborto, entendido éste como la pérdida del producto de la concepción que pesa menos de 500 g ó que ocurre antes de las 20 semanas. El estudio pretende describir el perfil epidemiológico de pacientes con diagnóstico de aborto en el Hospital Nacional Especializado de Maternidad durante el período de enero a diciembre del 2013 , pretende identificar de forma más puntual la incidencia de aborto; describir las características demográficas y gineco-obstétricas de las mujeres atendidas; cuantificar la estancia hospitalaria, de las mujeres atendidas por aborto; identificar el tipo de aborto más frecuente y su correlación anatomo-patológica; describir el tratamiento y complicaciones más frecuentemente brindado a las mujeres que consultaron por aborto. Es un estudio descriptivo, transversal y retrospectivo. Se realizó la compilación de datos a partir de la revisión de expediente clínico en el área de archivo y estadística. Además se realizó la búsqueda de los resultados a través de la verificación del reporte patológico de pacientes a quien se le haya realizado legrado. Las características más importantes y frecuentes fueron 21 y 30 años, áreas urbanas, área central del país, secundaria y tercer ciclo, nulíparas, unión libre, área nor-oriente de San Salvador, factores de riesgo más importantes aborto previo y paciente adolescente, solo un 6% periodo intergenésico de riesgo, diagnostico al ingreso abortos incompletos y estables en su mayoría, 92% de la población estudiada el pilar de tratamiento legrado, no se encontraron complicaciones posteriores al manejo de aborto en la mayoría, un poco más de la mitad de los casos se encontró reporte histopatológico anexado al expediente, y la gran mayoría prefirió ningún método de planificación familiar al alta.

Prevalencia de artritis séptica neonatal en un hospital universitario

Introducción: La artritis séptica neonatal es un padecimiento poco común que se ha relacionado con recién nacidos internados en la unidad de cuidados intensivos neonatal, cuyo principal factor de riesgo es el uso previo de catéter central. Objetivo: establecer la prevalencia de la artritis séptica neonatal en nuestro Hospital. Material y método: estudio observacional descriptivo de prevalencia. Se incluyeron todos los recién nacidos con diagnostico de artritis séptica neonatal internados un la unidad de cuidados intermedios e intensivos neonatal del Hospital Universitario Dr. José Eleuterio González del año 2003 al 2007. Se revisaron los expedientes y se registraron variables generales, factores de riesgo, bacteriología y mortalidad. Resultados: Se diagnosticaron 26 casos de artritis séptica neonatal durante el periodo de tiempo estudiado, solo 20 casos lograron criterios de inclusión: la prevalencia fue de 1.2 casos por cada 1,000 nacidos. La edad gestacional fue 39.2 ± 1.3 semanas, con peso 3193 ± 709 g. El factor de riesgo que se presento con mas frecuencia fue el antecedente de uso previo de catéter en 75% de los casos. Se aisló microorganismo en 80% de los casos, los bacterias grampositivas se aislaron en 80% de los casos; el Staphylococcus aureus fue el microorganismo aislado predominantemente en 75% de los casos. La presentación poliarticular fue en 40% de los casos. La mortalidad fue de 0%. Conclusiones: La prevalencia fue menor a lo reportado en la literatura. Los microorganismos grampositivos continúan siendo los microorganismos predominantes en la artritis séptica neonatal. La mortalidad es baja.

Neoadjuvant chemotherapy in Albinos with locally advanced skin cancer at a Blantyre Hospital: - Case Series

Albinism in Africa remains a public health concern with increasing numbers of advanced skin cancer in this population at presentation. There are challenges with availability of Radiotherapy (RT) units in Africa which is an important modality for controlling loco-regional disease alone or in combination with surgery. Proposed chemotherapy regimens have not been well validated through Randomized Controlled Trials thus posing difficulties for standard of care for units that do not have access to functional RT facilities. Malawi is one such country without radiotherapy. Case summary Seven patients with locally advanced skin cancer were seen in the adult oncology unit at Queen Elizabeth Central Hospital in Blantyre (QECH), Malawi between 2010 and 2013. QECH is one of the teaching hospitals in the country. All were subjected to neo-adjuvant chemotherapy. The primary treatment aim was cyto-reduction followed by surgery whilst the secondary outcome was general symptom control. Three patients achieved complete responses of which two underwent resection and a pectoralis major myocutaneous flap. One had a near complete response and three showed partial responses. Conclusion Neo-adjuvant chemotherapy may be a possible.

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.

Análise bioética do uso de artes expressivas no cuidado oncológico infantil em hospital público de Pernambuco

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Bioética, 2015.