Spinaalistenoosipotilaiden psyykkinen hyvinvointi ennen leikkaushoitoa ja sen jälkeen

Surgical treatment of lumbar spinal stenosis (LSS) is a treatment option for those patients who remain severely symptomatic after a course of conservative treatment. Majority of the patients treated surgically enjoy good-to-excellent outcomes with respect to pain alleviation and functional recovery. However, between 20% and 40% of the patients who have surgery for LSS do not benefit from it. The knowledge of the psychological factors associated with recovery and treatment outcome is still scarce. The aim of this study was to assess LSS patients selected for surgical treatment. Specifically, the study assessed the prevalence of depression (Beck Depression Inventory, BDI) before surgical treatment and three months after the treatment. Also preoperative life satisfaction (four-item Life Satisfaction scale) of the LSS patients was studied. Furthermore, the patients satisfaction with surgery outcome at the three months postoperative stage was studied. One-fifth (20%) of the LSS-patients were found to have depression preoperatively. The patients assessments of the pain intensity or location were not associated with depression. The factors that did associate with depression were subjective disability of everyday living and poor life satisfaction. In addition to this, low sense of coherence and poor life satisfaction were associated with depression in logistic regression models. Significant associations were seen between preoperative depression and postoperative high disability scores, high symptom severity scores and higher pain intensity ratings. The patients with continuous depression (60% of the patients who had preoperative depression) showed less improvement in symptom severity, disability, pain and walking capacity than the patients who did not experience depression at any stage. In those patients who recovered from depression (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. One-fourth (25%) of the preoperative patients with LSS were found to be dissatisfied with life. The dissatisfied patients were significantly younger and had more self-reported somatic comorbidity. The dissatisfied patients had also elevated subjective disability scores and more extensive pain locations. Also lower coping resources and higher BDI scores were associated with life dissatisfaction. Younger age and somatic comorbidity were associated with life dissatisfaction in regression models. Two-thirds (66%) of the patients were at least clearly satisfied with the surgery outcome at three months postoperative stage. In group comparisons, the lack of physical, functional and emotional well-being was associated with the patients dissatisfaction with the surgery outcome. Younger age, postoperative symptom severity, disability and depression were independently associated with dissatisfaction with the surgery outcome. The results show that depression and psychological well-being are important factors with respect to LSS patients functional ability and recovery both before and three months after surgical treatment. Therefore, the clinical practice recommendations should include an assessment of depression

On the environmental genetics of depressive symptoms : Focus on two serotonergic genes

Depression is a complex psychiatric disorder influenced by several genes, environmental factors, and their interplay. Serotonin receptor 2A (HTR2A) and tryptophan hydroxylase 1 (TPH1) genes have been implicated in vulnerability to depression and other psychiatric disorders, but the results have been inconsistent. The present study examined whether these two genes moderated the influence of different depressogenic environmental factors on subthreshold depressive symptoms (assessed on a modified version of Beck s Depression Inventory, BDI) and depression-related temperament, i.e., harm avoidance (assessed on the Temperament and Character Inventory, TCI). The environmental factors included measures of childhood and adolescence exposure, i.e., maternal nurturance and parental socioeconomic status, and adulthood social circumstances, i.e., perceived social support and urban/rural residence. The participants were two randomly selected subsamples (n = 1246, n = 341) from the longitudinal population-based Cardiovascular Risk in Young Finns study (n = 3596). Childhood environmental factors were assessed when the participants were 3 to 18 years of age, and three years after the baseline. Adulthood environmental factors and outcome measures were assessed 17 and 21 years later when the participants were 21 to 39 years of age. The T102C polymorphism of the HTR2A gene moderated the association between childhood maternal nurturance and adulthood depressive symptoms, such that exposure to high maternal nurturance predicted low depressive symptoms among individuals carrying the T/T or T/C genotypes, but not among those carrying the C/C genotype. Likewise, high parental SES predicted low adulthood harm avoidance in individuals carrying the T/T or T/C genotype, but not in C/C-genotype carriers. Individuals carrying the T/T or T/C genotype were also sensitive to urban/rural residence, such that they had lower depressive symptoms in urban than in rural areas, whereas those carrying the C/C genotype were not sensitive to urban/rural residence difference. HTR2A did not moderate the influence of social support. TheA779C/A218C haplotype of the TPH1 gene was not involved in the association between childhood environment and adulthood outcomes. However, individuals carrying A alleles of the TPH1 haplotype were more vulnerable to the lack of adulthood social support in terms of high depressive symptoms than their counterparts carrying no A alleles. Furthermore, individuals living in remote rural areas and carrying the A/A haplotype had higher depressive symptoms than those carrying other genotypes of the TPH1. The findings suggest that the HTR2A and TPH1 genes may be involved in the development of depression by influencing individual s sensitivity to depressogenic environmental influences.

Combustion studies on ammonium perchlorate/trimethylammonium perchlorate mixtures

A study of the burning rates of compressed mixtures of ammonium perchlorate (AP) and trimethylammonium perchlorate (TMAP) has been carried out at ambient pressure. The overall increase in the linear burning rate, showing a maximum at a composition having 80% TMAP, has been discussed in terms of factors such as stoichiometry, presence of faster burning component, and eutectic melt formation. The thermal decomposition studies of the mixtures, using isothermal thermogravimetry and differential thermal analysis techniques, indicate the possibility of eutectic melt formation.

Art changing the world: one person at a time

Dr Michael Whelan from Autism Queensland talks about a mentoring program supporting young people to develop creative industries skills… Following the extreme social stresses of high school, a lot of young people on the autism spectrum retreat to their bedrooms and computers to hibernate for extended periods of time. Online gaming communities and digital media hubs often provide a more accessible forum for young adults on the autism spectrum to establish and maintain social connections. A recent study suggests that school leavers on the autism spectrum in Queensland spend an average of 9.5 hours per day (68 hours per week) engaged in solitary technology-based activities. While this astonishing figure has its foundations in the sobering fact that most of these young people have limited social networks and experience significant anxiety and depression, it also serves to illustrate the extraordinary skill sets that these extended hours of technological engagement can facilitate.

Sensory Systems in Sawfishes. 2. The Lateral Line.

The lateral line system allows elasmobranchs to detect hydrodynamic movements in their close surroundings. We examined the distribution of pit organs and lateral line canals in 4 species of sawfish (Anoxypristis cuspidata, Pristis microdon, P. clavata and P. zijsron). Pit organs could only be located in A. cuspidata, which possesses elongated pits that are lined by dermal denticles. In all 4 pristid species, the lateral line canals are well developed and were separated into regions of pored and non-pored canals. In all species the tubules that extend from pored canals form extensive networks. In A. cuspidata, P. microdon and P. clavata, the lateral line canals on both the dorsal and ventral surfaces of the rostrum possess extensively branched and pored tubules. Based on this morphological observation, we hypothesized that these 3 species do not use their rostrum to search in the substrate for prey as previously assumed. Other batoids that possess lateral line canals adapted to perceive stimuli produced by infaunal prey possess non-pored lateral line canals, which also prevent the intrusion of substrate particles. However, this hypothesis remains to be tested behaviourally in pristids. Lateral line canals located between the mouth and the nostrils are non-pored in all 4 species of sawfish. Thus this region is hypothesized to perceive stimuli caused by direct contact with prey before ingestion. Lateral line canals that contain neuromasts are longest in P. microdon, but canals containing neuromasts along the rostrum are longest in A. cuspidata.

Psychological consequences of false-positive screening mammograms in the UK

- Objectives To identify the psychological effects of false-positive screening mammograms in the UK. - Methods Systematic review of all controlled studies and qualitative studies of women with a false-positive screening mammogram. The control group participants had normal mammograms. All psychological outcomes including returning for routine screening were permitted. All studies had a narrative synthesis. - Results The searches returned seven includable studies (7/4423). Heterogeneity was such that meta-analysis was not possible. Studies using disease-specific measures found that, compared to normal results, there could be enduring psychological distress that lasted up to 3 years; the level of distress was related to the degree of invasiveness of the assessment. At 3 years the relative risks were, further mammography, 1.28 (95% CI 0.82 to 2.00), fine needle aspiration 1.80 (95% CI 1.17 to 2.77), biopsy 2.07 (95% CI 1.22 to 3.52) and early recall 1.82 (95% CI 1.22 to 2.72). Studies that used generic measures of anxiety and depression found no such impact up to 3 months after screening. Evidence suggests that women with false-positive mammograms have an increased likelihood of failing to reattend for routine screening, relative risk 0.97 (95% CI 0.96 to 0.98) compared with women with normal mammograms. - Conclusions Having a false-positive screening mammogram can cause breast cancer-specific distress for up to 3 years. The degree of distress is related to the invasiveness of the assessment. Women with false-positive mammograms are less likely to return for routine assessment than those with normal ones.

Storage stability of solid rocket fuels. 2. Effect of oxidizer loadings

Ageing behaviour, leading to ballistic changes, has been studied as a function of oxidizer loading in polystyrene/ammonium perchlorate solid-propellants. The ageing studies were carried out at 100 °C in air. Change in burning rate decreased as the oxidizer loading increased from 75 to 80%. The change in thermal decomposition rates both at 230 and 260 °C also decreased as the oxidizer loading in the propellants increased. The shapes of the plots of the changes in burning rate and thermal decomposition rate (230 and 260 °C) at different storage times for different oxidizer-loaded propellants seem to be exactly similar. These results lead to the conclusion that the thermal decomposition of the propellant may be responsible for bringing about the ballistic changes during the ageing process. Infrared studies of the binder portion of the aged propellant indicate that peroxide formation takes place during the course of ageing and that peroxide formation for a particular storage time and temperature increases as the loading decreases.

Sex steroids in Sjögren's syndrome

Sjögren s syndrome (SS) is a strongly female dominant autoimmune disease. SS targets mainly salivary and lacrimal glands and leads to loss of the secreting acinar cells of these glands. Accordingly, secretion of the affected glands is diminished and the main symptoms of SS, dryness of mouth and eyes, follow. In addition to these sicca symptoms, SS patients suffer from severe fatigue and can have various extraglandular symptoms. To date, the etiology of SS still remains unknown. Female dominance and the late onset of the disease simultaneously with remarkable hormonal changes in the body (menopause, adrenopause) encouraged us to hypothesize that sex steroids, especially androgens, are involved in the onset and progression of SS. We confirmed our hypothesis and showed that patients with SS suffer from androgen depletion both systemically and locally in the target tissue of SS, salivary glands. We especially focused on the local androgen environment in salivary glands and demonstrated that healthy salivary glands contain a complete enzymatic machinery for local synthesis of androgens and estrogens from pro-hormone dehydroepiandrosterone (DHEA). However, in SS salivary glands the enzymes catalyzing the local androgen synthesis are defective and, in a subgroup of patients, practically non-functional. Probably due to this local defect in DHEA processing, therapy with DHEA was found unbeneficial for SS patients in the treatment of fatigue. We also studied the effect of the local androgen depletion on salivary glands. We found that in salivary gland cells and healthy labial salivary glands androgens upregulate integrin subunits α1 and α2, which are important for the communication, differentiation and function of the acinar cells. On the contrary, in SS salivary glands DHEA failed to upregulate these signaling molecules, again probably due to defective processing of DHEA into active androgens. Our finding highlights the importance of the local androgen environment and local DHEA processing for the function and welfare of salivary glands. In conclusion, this study showed that patients with SS are androgen depleted both systemically and locally in salivary glands. SS patients also have a defective local sex steroid synthesizing enzymatic machinery further impairing the local androgen depletion. We also showed that the local androgen defect leads to decreased expression of acinar cell specific integrin molecules, which impairs the signaling between the acinar cells and basement membrane and might thus explain the acinar cell loss seen in SS salivary glands. By showing the importance of the local sex steroid imbalance in SS we have clarified some etiopathogenetic mechanisms of SS, which have thus far remained unknown.

Biomassan energia-arvon nostaminen sekundäärilämmöllä kuivaamalla

Viime aikoina ilmastonmuutos, fossiilisten polttoaineiden väheneminen ja niiden hinnan nousu ovat lisänneet merkittävästi maailmanlaajuista kiinnostusta uusiutuviin energiavaroihin. Suomessa uusiutuvien energialähteiden käytössä on jo pitkään panostettu metsäteollisuuden sivutuotevirtana tuottamaan puuperäiseen biomassaan, jota metsäteollisuus käyttää energiantuotantoonsa. Metsäteollisuuden jätevesien käsittelyssä syntyy erilaisia lietteitä, jotka joko uusiokäytetään tai hävitetään polttamalla tai sijoittamalla kaatopaikalle. Erityisesti biolietteiden uusiokäyttö on hankalaa ja kaatopaikkasijoitus tulevaisuudessa mahdotonta tai ainakin kustannuksiltaan kohtuutonta. Käytännössä liete hävitetään polttamalla ja kuivaamalla siitä tulee polttoaine. Lietteiden energiakäyttö on järkevin tapa hävittää jäteliete. Lietteiden korkean vesipitoisuuden vuoksi ne tulee kuitenkin kuivata ennen polttoa. Lietteen kuivaaminen sekundäärienergiavirralla eli metsäteollisuusprosesseissa sivutuotteena muodostuvalla ns. hukkalämmöllä lisää lietteen poltosta saatavaa energiamäärää ja korvaa fossiilisten polttoaineiden käyttöä. Tutkimuksen tavoitteena oli selvittää lietteen kuivaukseen optimaalisin kuoren ja lietteen seossuhde eri kuivausparametrejä vaihdellen. Kokeellinen työ aloitettiin rakentamalla energiatekniikan koehalliin laboratoriokokoluokan kiintopetikuivuri, jossa kuivumista tutkittiin puhaltamalla polttoainepedin läpi lämmitettyä ilmaa. Kuivattavina polttoaineina olivat kuoren ja lietteen seos tai pelkkä kuori ja liete erilaisilla massoilla ja erilaisilla prosenttisilla suhteilla ja erilaisissa lämpötiloissa. Kuivumiskäyrien määritys perustui massanmuutokseen. Koelaitteessa olivat anturit lämpötilan mittausta varten, jotta lämpötila saatiin säädettyä ja seurattua kokeen edellyttämällä tavalla. Lämpötilat ja painonmuutokset tallentuivat koetta tehdessä tietokoneelle. Kuivauskokeet osoittivat, että liete-kuori seos kuivuu hyvin kiintopedissä kun lietteen massaosuus seoksessa on korkeintaan 50 %. Lietteen massaosuuden ollessa tätä suurempi kuivaaminen ei enää ole tehokasta, mikä johtuu luultavasti ilman suuresta kanavoitumisesta kuivauspedissä. Kuorta kuivatessa lämpötilan nosto 50 °C:stä 70 °C:een oli huomattavasti tehokkaampaa kuin 70 °C:stä 90 °C:een, ajallisesti ero oli noin kaksinkertainen.

Analysis of a cracked lug loaded by an interference fit pin

In the present study, a lug joint fitted with an interference fit (oversized) pin is considered with radial through cracks situated at diametrically opposite points perpendicular to the loading direction. A finite element contact stress algorithm is developed with linear elastic assumptions to deal with varying partial contact/separation at the pin-plate interface using a marching solution. Stress Intensity Factor (SIF) at the crack tips is evaluated using the Modified Crack Closure Integral (MCCI) method. The effect of change in crack length and edge distance on the load-contact relation, SIFs and stress distributions are studied. A rigorous plane stress elasticity solution of the pin-plate interface at the crack mouth confirmed the existence of the stress concentration leading to a local peak in the radial stress at the crack mouth and provided a method of estimating it quantitatively. Copyright (C) 1996 Elsevier Science Ltd.

Análisis de la relación entre optimismo, calidad de vida y estabilidad emocional en personas con cáncer

Resumen: Este estudio se propuso analizar la relación del optimismo con ansiedad, depresión y calidad de vida global en una muestra de 45 pacientes oncológicos, 34% hombres y 66% mujeres con un promedio de 50,5 años y un rango de 21 a 74 años. Según la localización de la neoplasia se conformó una muestra mixta. Para este trabajo se realizó un muestreo no probabilístico con control de las variables: estadio de la enfermedad, fase y tipo de tratamiento médico/clínico, equipo médico actuante y enfermedades concomitantes. Cumplió con las normas éticas establecidas (FePRA, 2013; Helsinki, 2008). Para evaluar optimismo se administró la versión española del LOT-R (Otero, Luengo, Romero y Castro, 1998), para Calidad de Vida el cuestionario FACT-G en su 4ta versión (Cella, Tulsky, Gray, 1993) y para ansiedad y depresión la versión española de la escala HAD (Caro & Ibáñez, 1992). Se encontraron correlaciones significativas entre optimismo con cada una de las variables en estudio y se reportaron diferencias significativas entre los pesimistas y los optimistas en Ansiedad (F= 6.35, p = .015); Depresión (F= 5.30, p = .026) y Calidad de Vida (F= 8.99, p = .004).

Depresión y calcificación en la raíz aórtica y arterias coronarias

Resumen: Se estudia, en adultos de ambos sexos, la asociación entre la depresión y la presencia simultánea de calcificación en las arterias coronarias y la raíz aórtica por un lado, y entre la depresión y la presencia de calcificación coronaria, por otro lado. Estudio transversal. Participaron mayores de 21 años, asintomáticos, sin antecedentes coronarios, que se realizaron una angiotomografía cardíaca por indicación del médico tratante y que fueron evaluados para la depresión. La presencia de calcificación se evaluó mediante angiotomografía cardíaca. La depresión se evaluó mediante un test psicológico. Resultados: 60 adultos, 30 hombres y 30 mujeres, media de 51 ± 5 años. Encontramos una asociación de mayor fortaleza entre la depresión y la calcificación en dos ubicaciones (calcificación coronaria y aórtica) que en un solo lugar (calcificación coronaria). Las personas con calcificación coronaria y aórtica puntuaron más alto en las pruebas de depresión que las personas con calcificación coronaria únicamente. El presente estudio tiene limitaciones debido al tamaño de la muestra y el diseño utilizado. Sin embargo, los resultados sugieren que podría ser interesante estudiar una muestra más grande, con un diseño prospectivo, teniendo en cuenta otras variables intervinientes. Los resultados del presente trabajo confirmaron la presencia simultánea de la depresión y las lesiones ateroscleróticas. Se sugieren dos preguntas: si el tratamiento de la depresión podría modificar el proceso de evolución de las lesiones, y viceversa, y si una intervención terapéutica en ambos (enfermedad aterosclerótica y la depresión), sería más acertada que sólo realizar el tratamiento de la enfermedad aterosclerótica.

On crack path stability in a layered material

Crack paths in an elastic layer on top of a substrate are considered. Crack growth is initiated from an edge crack in the layer. The plane of the initially straight crack forms an angle to the free surface. The load consists of a pair of forces applied at the crack mouth and parallel to the interface. Crack paths are calculated using a boundary element method. Crack growth is assumed to proceed along a path for which the mode II stress intensity factor vanishes. The inclination and the length of the initial crack are varied. The effect of two different substrates on the crack path evolution is demonstrated. A crack path initially leading perpendicularly to the interface is shown to be directionally unstable for a rigid substrate. Irrespective of its initial angle, the crack does not reach the interface, but reaches the free surface if the layer is infinitely long. At finite layer length the crack reaches the upper free surface if the initial crack inclination to the surface is small enough. For an inextendable flexible substrate, on the other hand, the crack reaches the interface if its initial inclination is large enough. For the flexible substrate an unstable path parallel with the sides of an infinitely long layer is identified. The results are compared with experimental results and discussed in view of characterisation of directionally unstable crack paths. The energy release rate for an inclined edge crack is determined analytically.

Plasma-Arc Technology For The Thermal Treatment Of Chemical Wastes

Plasma-arc technology was developed to dispose of chemical wastes from a chemical plant by the Institute of Mechanics, Chinese Academy of Sciences (CAS-IMECH). A pilot plant system with this technology was constructed to destroy two types of chemical wastes. The system included shredding, mixing, and feeding subsystems, a plasma-arc reactor of 150 kW, an off-gas burning subsystem, and a scrubbing subsystem. The additives (CaO, SiO2, and Fe) were added into the reactor to form vitrified slag and capture the hazardous elements. The molten slag was quickly quenched to form an amorphous glassy structure. A direct current (DC) experimental facility of 30kW with plasma-arc technology was also set up to study the pyrolysis process in the laboratory, and the experimental results showed the cooling speed is the most important factor for good vitrified structure of the slag. According to previous tests, the destruction and removal efficiency (DRE) for these chemical wastes was more than 99.999%, and the polychlorinated biphenyls (PCBs) concentration in the solid residues was in the range of 1.28 to 12.9mg/kg, which is far below the Chinese national emission limit for the hazardous wastes. A simplified electromagneto model for numerical simulation was developed to predict the temperature and velocity fields. This model can make satisfactory maximum temperature and velocity distributions in the arc region, as well as the results by the magneto hydrodynamic approach.

Riscos ocupacionais e problemas de saúde associados às condições de trabalho de enfermagem em unidades intensivas hospitalares

Trata-se de um estudo quantitativo, descritivo, visando uma análise das condições de trabalho em unidades intensivas de um hospital universitário no município do Rio de Janeiro. Foi definido como objeto de estudo a percepção dos trabalhadores de enfermagem sobre os riscos ocupacionais e os problemas de saúde inerentes às condições de trabalho em unidades intensivas e como problema de pesquisa: quais os riscos ocupacionais e problemas de saúde relacionados às condições de trabalho, percebidos pelos trabalhadores de enfermagem, em unidades intensivas de um hospital universitário? O objetivo geral foi estudar nas unidades intensivas os riscos ocupacionais e problemas de saúde da equipe de enfermagem e sua relação com condições de trabalho, a partir da percepção dos mesmos. Os objetivos específicos traçados foram: identificar as características pessoais e profissionais dos trabalhadores de enfermagem de unidades intensivas; descrever os fatores de risco do ambiente de trabalho percebidos pelos trabalhadores de enfermagem; levantar os problemas de saúde percebidos pelos trabalhadores e sua relação com o trabalho; analisar a associação entre os problemas de saúde percebidos pelos trabalhadores de enfermagem e as condições do trabalho em unidades intensivas. Participaram da pesquisa 125 profissionais de enfermagem de quatro unidades intensivas do Hospital Universitário (HU) entre Maio e Julho de 2009. A predominância foi de profissionais do sexo feminino, com idade acima dos 40 anos, com mais de um vínculo empregatício e trabalhando no HU há mais de 10 anos. Os riscos ocupacionais mais percebidos pelos trabalhadores foram os ergonômicos, seguido dos biológicos, de acidentes, físicos e químicos. Os problemas de saúde mais frequentes foram varizes, problemas oculares, lombalgias, estresse e depressão, transtornos do sono, lesões de coluna vertebral, dores de cabeça, mudanças no humor, dores musculares crônicas e hipertensão arterial. Pela associação entre riscos ocupacionais e problemas de saúde, conclui-se que os trabalhadores expostos a fatores de riscos ergonômicos e físicos têm maior probabilidade de adquirir problemas de saúde osteoarticulares e circulatórios (varizes). Diante dos dados desta pesquisa faz-se necessário aprofundamento da investigação sobre os fatores de riscos encontrados e possíveis medidas para minimizá-los, mediante novos estudos. Como recomendações destacam-se a criação de um espaço de discussão entre os gerentes e trabalhadores para a elaboração de um programa que vise a promoção e proteção da saúde do trabalhador de enfermagem de unidades intensivas; implementação de medidas de controle específicas para cada tipo de risco evidenciado e a criação de um Comitê de Ergonomia para operacionalizar a implementação das melhorias no HU, a fim de consolidar as transformações esperadas.