Important excess morbidity due to upper airway anomalies in the perioperative course in infant cardiac surgery

BACKGROUND: The study aimed at defining the excess morbidity or mortality caused by an additional airway malformation in children with congenital heart disease requiring surgery. METHODS: All patients requiring surgery for heart disease during an 8-year period ending in 2003 who had an associated upper airway malformation were retrospectively studied. All patients were seen in 2004 for a prospective follow-up examination. RESULTS: Eleven patients with upper airway anomalies were identified (tracheobronchial malacia in 6 patients, long-segment tracheal stenosis in 3, and bilateral vocal cord paralysis and tracheal hemangioma in 1 patient each). They accounted for 1.5% of the entire cardiac surgical load of 764 patients. In 5 infants, the airway anomaly was diagnosed before cardiac repair, in 6 patients thereafter. Diagnosis was made by bronchoscopy in all patients, by additional bronchography in 2. Failure of rapid postoperative extubation was the most common finding. Airway management was surgical in 2 and conservative in 8 patients, 1 newborn having been denied therapy because of the severity of airway hypoplasia. Compared with patients with isolated cardiac disease, those with additional airway anomalies had significantly longer duration of postoperative mechanical ventilation (median, 24 days versus 3), perioperative hospitalization (median, 72 days versus 11) and total number of days of hospitalization during the first year of life (median, 104 days versus 14). After a maximum follow-up of 8 years (median, 37 months) only 3 of 10 surviving patients remained symptomatic owing to the airway malformation. CONCLUSIONS: Upper airway anomalies accompanying heart disease in infancy resulted in a significant prolongation of perioperative intensive care and hospital stay, as well as duration of mechanical ventilation. Failure of early postoperative extubation was the leading symptom.

Frequency of spontaneous ventricular tachycardia in a pediatric population

Few data exist on the incidence of spontaneously occurring ventricular tachycardia (VT) in an unselected pediatric population. The aim of this study was to define the incidence and outcomes of VT in a general pediatric population. A retrospective analysis was performed of all documented episodes of VT in children referred to a single center during a 10-year study period ending in December 2005. The study center drains a stable referral area with 252,000 children aged <16 years, with no other pediatric cardiologic or pediatric intensive care services available. Twenty-seven patients with spontaneously occurring episodes of VT were observed, accounting for a VT incidence of 1.1 episodes/100,000 childhood years. Thirteen patients had VT in the absence of structural heart disease, and 14 had VT in the presence of a wide range of underlying cardiac disease. Overall mortality was 5 of 27 patients (19%), but mortality was seen exclusively in patients with underlying heart disease; for this subgroup of patients, mortality was 36%. Idiopathic VT in children with structurally normal hearts carried a good prognosis, and treatment was required in a minority (20%) of these patients. In conclusion, this study highlights that VT in childhood is rare, and outcomes are highly dependent on the underlying pathologic substrate.

The cyclotron laboratory and the RFQ accelerator in Bern

Two proton accelerators have been recently put in operation in Bern: an 18 MeV cyclotron and a 2 MeV RFQ linac. The commercial IBA 18/18 cyclotron, equipped with a specifically conceived 6 m long external beam line ending in a separate bunker, will provide beams for routine 18-F and other PET radioisotope production as well as for novel detector, radiation biophysics, radioprotection, radiochemistry and radiopharmacy developments. The accelerator is embedded into a complex building hosting two physics laboratories and four Good Manufacturing Practice (GMP) laboratories. This project is the result of a successful collaboration between the Inselspital, the University of Bern and private investors, aiming at the constitution of a combined medical and research centre able to provide the most cutting-edge technologies in medical imaging and cancer radiation therapy. The cyclotron is complemented by the RFQ with the primary goals of elemental analysis via Particle Induced Gamma Emission (PIGE), and the detection of potentially dangerous materials with high nitrogen content using the Gamma-Resonant Nuclear Absorption (GRNA) technique. In this context, beam instrumentation devices have been developed, in particular an innovative beam profile monitor based on doped silica fibres and a setup for emittance measurements using the pepper-pot technique. On this basis, the establishment of a proton therapy centre on the campus of the Inselspital is in the phase of advanced study.

Objective Mapping of Argo data in the Weddell Gyre: a gridded dataset of upper ocean water properties, link to data files in NetCDF format

The Weddell Gyre plays a crucial role in the regulation of climate by transferring heat into the deep ocean through deep and bottom water mass formation. However, our understanding of Weddell Gyre water mass properties is limited to regions of data availability, primarily along the Prime Meridian. The aim is to provide a dataset of the upper water column properties of the entire Weddell Gyre. Objective mapping was applied to Argo float data in order to produce spatially gridded, time composite maps of temperature and salinity for fixed pressure levels ranging from 50 to 2000 dbar, as well as temperature, salinity and pressure at the level of the sub-surface temperature maximum. While the data are currently too limited to incorporate time into the gridded structure, the data are extensive enough to produce maps of the entire region across three time composite periods (2002-2005, 2006-2009 and 2010-2013), which can be used to determine how representative conclusions drawn from data collected along general RV transect lines are on a gyre scale perspective. The time composite data sets are provided as netCDF files; one for each time period. Mapped fields of conservative temperature, absolute salinity and potential density are provided for 41 vertical pressure levels. The above variables as well as pressure are provided at the level of the sub-surface temperature maximum. Corresponding mapping errors are also included in the netCDF files. Further details are provided in the global attributes, such as the unit variables and structure of the corresponding data array (i.e. latitude x longitude x vertical pressure level). In addition, all files ending in "_potTpSal" provide mapped fields of potential temperature and practical salinity.

Localization of alpha type II calcium calmodulin-dependent protein kinase at glutamatergic but not gamma-aminobutyric acid (GABAergic) synapses in thalamus and cerebral cortex.

The alpha subunit of type II calcium/calmodulin-dependent protein kinase (CAM II kinase-alpha) plays an important role in longterm synaptic plasticity. We applied preembedding immunocytochemistry (for CAM II kinase-alpha) and postembedding immunogold labeling [for glutamate or gamma-aminobutyric acid (GABA)] to explore the subcellular relationships between transmitter-defined axon terminals and the kinase at excitatory and inhibitory synapses in thalamus and cerebral cortex. Many (but not all) axon terminals ending in asymmetric synapses contained presynaptic CAM II kinase-alpha immunoreactivity; GABAergic terminals ending in symmetric synapses did not. Postsynaptically, CAM II kinase-alpha immunoreactivity was associated with postsynaptic densities of many (but not all) glutamatergic axon terminals ending on excitatory neurons. CAM II kinase-alpha immunoreactivity was absent at postsynaptic densities of all GABAergic synapses. The findings show that CAM II kinase-alpha is selectively expressed in subpopulations of excitatory neurons and, to our knowledge, demonstrate for the first time that it is only associated with glutamatergic terminals pre- and postsynaptically. CAM II kinase-alpha is unlikely to play a role in plasticity at GABAergic synapses.

Complexidade textual e progressão escolar em dois registos : um estudo de correlação baseado em um corpus quasi-longitudinal

Tese de doutoramento, Linguística (Linguística Educacional), Universidade de Lisboa, Faculdade de Letras, 2016

Shall Tunisia Succeed in Becoming a Strong Democratic State? EUSpring Arab Citizenship Review No. 13, December 2015

From the Introduction. Arab revolutions have sparked real hopes for democracy, but the situation varies from one state to another and change has taken various directions, with unpredictable outcomes in the future. In light of current events, most of these countries seem to have failed in their democratic transition and also face the dissolution of their state apparatus in bloody civil wars. This leaves the door open to interpretations associating democracy with chaos. In this view, preserving post-colonial states – authoritarian in most cases – is better than having no state at all. This partially justified the coup that took place in Egypt, where the ‘Deep State’ has recovered its capabilities in a dictatorial manner. The Arab world thus faced an impasse: the state is either stable but authoritarian or democratic yet threatened with dissolution. The dilemma results in an impossible choice between stable dictatorship or freedom ending in chaos.

Abortion in the United States: Occurrence, trends, cross-state care-seeking and unmet need

Thesis (Master's)--University of Washington, 2016-08

Study of tRNA modifying enzymes and codon usage bias in cancer

Recent evidences indicate that tRNA modifications and tRNA modifying enzymes may play important roles in complex human diseases such as cancer, neurological disorders and mitochondrial-linked diseases. We postulate that expression deregulation of tRNA modifying enzymes affects the level of tRNA modifications and, consequently, their function and the translation efficiency of their tRNA corresponding codons. Due to the degeneracy of the genetic code, most amino acids are encoded by two to six synonymous codons. This degeneracy and the biased usage of synonymous codons cause alterations that can span from protein folding to enhanced translation efficiency of a select gene group. In this work, we focused on cancer and performed a meta-analysis study to compare microarray gene expression profiles, reported by previous studies and evaluate the codon usage of different types of cancer where tRNA modifying enzymes were found de-regulated. A total of 36 different tRNA modifying enzymes were found de-regulated in most cancer datasets analyzed. The codon usage analysis revealed a preference for codons ending in AU for the up-regulated genes, while the down-regulated genes show a preference for GC ending codons. Furthermore, a PCA biplot analysis showed this same tendency. We also analyzed the codon usage of the datasets where the CTU2 tRNA modifying enzyme was found deregulated as this enzyme affects the wobble position (position 34) of specific tRNAs. Our data points to a distinct codon usage pattern between up and downregulated genes in cancer, which might be caused by the deregulation of specific tRNA modifying enzymes. This codon usage bias may augment the transcription and translation efficiency of some genes that otherwise, in a normal situation, would be translated less efficiently.

The subjunctive mood in Late Middle English adverbial clauses: the interaction of form and function

This thesis focuses on the history of the inflexional subjunctive and its functional substitutes in Late Middle English. To explore why and how the inflexional subjunctive declined in the history of English language, I analysed 2653 examples of three adverbial clauses introduced by if (1882 examples), though (305 examples) and lest (466 examples). Using a corpus-based approach, this thesis argues that linguistic change in subjunctive constructions did not happen suddenly but rather gradually, and the way it changed was varied , and that different constructions changed at different speeds in different environments. It is well known that the inflexional subjunctive declined in the history of English, mainly because of inflexional loss. Strangely however this topic has been comparatively neglected in the scholarly literature, especially with regard to the Middle English period, probably due to the limitations of data and also because study of this development requires very cumbersome textual research. This thesis has derived and analysed the data from three large corpora in the public domain: the Middle English Grammar Corpus (MEG-C for short), the Innsbruck Computer Archive of Machine-Readable English Texts (ICAMET for short), and some selected texts from The Corpus of Middle English Prose and Verse, part of the Middle English Compendium that also includes the Middle English Dictionary. The data were analysed from three perspectives: 1) clausal type, 2) dialect, and 3) textual genre. The basic methodology for the research was to analyse the examples one by one, with special attention being paid to the peculiarities of each text. In addition, this thesis draw on some complementary – indeed overlapping -- linguistic theories for further discussion: 1) Biber’s multi-dimensional theory, 2) Ogura and Wang’s (1994) S-curve or ‘diffusion’ theory, 3) Kretzchmar’s (2009) linguistics of speech, and 4) Halliday’s (1987) notion of language as a dynamic open system. To summarise the outcomes of this thesis: 1) On variation between clausal types, it was shown that the distributional tendencies of verb types (sub, ind, mod) are different between the three adverbial clauses under consideration. 2) On variation between dialects, it has been shown that the northern area, i.e. the so-called Great Scandinavian Belt, displays an especially high comparative ratio of the inflexional subjunctive construction compared to the other areas. This thesis suggests that this result was caused by the influence of Norse, relating the finding to the argument of Samuels (1989) that the present tense -es ending in the northern dialect was introduced by the influence of the Scandinavians. 3) On variation between genres, those labelled Science, Documents and Religion display relatively high ratio of the inflexional subjunctive, while Letter, Romance and History show relatively low ratio of the inflexional subjunctive. This results are explained by Biber’s multi-dimensional theory, which shows that the inflexional subjunctive can be related to the factors ‘informational’, ‘non-narrative’, ‘persuasive’ and ‘abstract’. 4) Lastly, on the inflexional subjunctive in Late Middle English, this thesis concludes that 1) the change did not happen suddenly but gradually, and 2) the way language changes varies. Thus the inflexional subjunctive did not disappear suddenly from England, and there was a time lag among the clausal types, dialects and genres, which can be related to Ogura and Wang’s S-curve (“diffusion”) theory and Kretzchmars’s view of “linguistic continuum”. This thesis has shown that the issues with regard to the inflexional subjunctive are quite complex, so that research in this area requires not only textual analysis but also theoretical analysis, considering both intra- and extra- linguistic factors.

I solai in legno. Recupero e rifunzionalizzazione di un fabbricato presso il Centro Spirituale di Marola (RE)

L'oggetto della tesi riguarda lo studio dei solai in legno esistenti, inizialmente dal punto di vista teorico, affrontando esempi e problematiche strutturali relative a tale tecnologia. Successivamente si è affrontato lo studio di un fabbricato, attualmente inutilizzato e con i solai e copertura in un pessimo stato di conservazione. Il progetto riguarda un edificio sito a Marola, piccolo comune dell’appennino reggiano. Il fabbricato denominato “Casa del Contadino” fa parte del complesso del Centro Diocesano di Spiritualità e Cultura di Marola. La proposta di progetto riguarda la realizzazione di aule didattiche e di un museo etnografico nel complesso “Casa del contadino” per offrire più opportunità ai turisti religiosi e non che sono ospiti del seminario. Si è partito da un accurato studio sullo stato di fatto dell’edificio, mediante un dettagliato rilievo geometrico e strutturale. Da questo punto di partenza sono in iniziate le ipotesi di intervento, valutando le carenze strutturali del fabbricato e avendo in mente le destinazioni d’uso finali, già descritte sopra. Si sono quindi studiati i dettagli costruttivi relativi all’intervento di consolidamento della copertura lignea, dei solai lignei, sul paramento murario e infine alcune ipotesi di consolidamento delle fondazioni. Di pari passo al disegno tecnico e progettuale, sono stati portati avanti anche calcoli statici riguardanti dimensionamento e verifica della copertura, dei solai e dei principali paramenti murari, che definiscono a livello numerico le strategie d’intervento per un futuro studio diagnostico accurato della struttura.

Morfologia dos órgãos genitais masculinos do Jurará Kinosternon scorpioides (Chelonia: Kinosternidae)

Kinosternon scorpioides é uma pequena tartaruga semi-aquática, típica de água doce, de distribuição geográfica bastante diversificada, encontrada no estado do Maranhão, onde é denominada de jurará ou muçuã. Sua carne é uma excelente fonte de proteína e a despeito da legislação vigente, é comercializado nas praias e feiras da cidade de São Luís e consumido nos restaurantes sob a forma de farofa servida em casquinha. Os órgãos genitais do macho foram estudados visando fornecer dados morfológicos da própria espécie, que poderão ser utilizados na biologia reprodutiva voltada para ações de preservação em cativeiro. Compõe-se a amostra de 10 machos adultos, obtidos mediante apreensões do IBAMA-MA (Proc. nº 020.12.002400/99-31, licença nº 002/01), os quais foram eutanaziados conforme normas do Comitê de Ética do Curso de Medicina Veterinária, Universidade Estadual do Maranhão. A cavidade celomática foi aberta e os órgãos fixados em solução aquosa de formaldeído 10%, e posteriormente dissecados. Os testículos possuem formato ovóide e coloração amarelo-ouro. Os epidídimos convolutos estavam aderidos dorsalmente à superfície medial dos testículos, terminando em um pequeno ducto deferente. Os ductos deferentes não forma-ram nenhuma ampola distinta, abrindo-se na cloaca. O pênis sulcado, localizado no assoalho da cloaca, estendeu-se até a cauda, composto de raíz, corpo e glande. A morfologia dos órgãos reprodutivos destes animais assemelha-se aos de outras tartarugas, sugerindo uma morfologia conservada entre as tartarugas.

Multidimensional aspects related to shiftworkers' health and well-being

The impact of shift and night work on health shows a high inter- and intra-individual variability, both in terms of kind of troubles and temporal occurrence, related to various intervening factors dealing with individual characteristics, lifestyles, work demands, company organisation, family relations and social conditions. The way we define "health" and "well-being" can significantly influence appraisals, outcomes and interventions. As the goal is the optimisation of shiftworkers' health, it is necessary to go beyond the health protection and to act for health promotion. In this perspective, not only people related to medical sciences, but many other actors (ergonomists, psychologists, sociologists, educators, legislators), as well as shiftworkers themselves. Many models have been proposed aimed at describing the intervening variables mediating and/or moderating the effects; they try to define the interactions and the pathways connecting risk factors and outcomes through several human dimensions, which refer to physiology, psychology, pathology, sociology, ergonomics, economics, politics, and ethics. So, different criteria can be used to evaluate shiftworkers' health and well-being, starting from biological rhythms and ending in severe health disorders, passing through psychological strain, job dissatisfaction, family perturbation and social dis-adaptation, both in the short- and long-term. Consequently, it appears rather arbitrary to focus the problem of shiftworkers' health and tolerance only on specific aspects (e.g. individual characteristics), but a systemic approach appears more appropriate, able to match as many variables as possible, and aimed at defining which factors are the most relevant for those specific work and social conditions. This can support a more effective and profitable (for individuals, companies, and society) adoption of preventive and compensative measures, that must refer more to "countervalues" rather than to "counterweights".

Impact of maritime air mass trajectories on the Western European coast urban aerosol

Lisbon is the largest urban area in the Western European coast. Due to this geographical position the Atlantic Ocean serves as an important source of particles and plays an important role in many atmospheric processes. The main objectives of this study were to (1) perform a chemical characterization of particulate matter (PM2.5) sampled in Lisbon, (2) identify the main sources of particles, (3) determine PM contribution to this urban area, and (4) assess the impact of maritime air mass trajectories on concentration and composition of respirable PM sampled in Lisbon. During 2007, PM2.5 was collected on a daily basis in the center of Lisbon with a Partisol sampler. The exposed Teflon filters were measured by gravimetry and cut into two parts: one for analysis by instrumental neutron activation analysis (INAA) and the other by ion chromatography (IC). Principal component analysis (PCA) and multilinear regression analysis (MLRA) were used to identify possible sources of PM2.5 and determine mass contribution. Five main groups of sources were identified: secondary aerosols, traffic, calcium, soil, and sea. Four-day backtracking trajectories ending in Lisbon at the starting sampling time were calculated using the HYSPLIT model. Results showed that maritime transport scenarios were frequent. These episodes were characterized by a significant decrease of anthropogenic aerosol concentrations and exerted a significant role on air quality in this urban area.

O impacto do ensino de estratégias ou morfológicas ou fonológicas na escrita de morfemas homófonos: estudo de intervenção

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção de grau de Mestre em Ciências da Educação - Especialização em Educação Especial