Bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: Avalon© cannula in childhood disease.

Severe acute refractory respiratory failure is considered a life-threatening situation, with a high mortality of 40 to 60%. When conservative oxygenation methods fail, a lifesaving measure is the introduction of extracorporeal membrane oxygenation (ECMO). Venovenous ECMO (VV-ECMO) is a preferred modality of support for patients with refractory acute respiratory failure. Specifically, bicaval VV-ECMO is a well-recognized and validated therapy, where single or double periphery venous access is used for the insertion of two differently sized cannulas in order to achieve adequate blood oxygenation. Compared to venoarterial ECMO, in VV-ECMO, the rate of complications, such as thrombosis, bleeding, infection and ischemic events, is lower. On the other hand, the size and insertion location is an obstacle to patient mobilization. This is a considerable problem for patients where the time interval for lung recovery and the bridge to the transplantation is prolonged. To address this issue, a dual-lumen, single venovenous cannula was introduced. Here, by insertion of one single catheter in one target vessel, in a majority of cases in the right internal jugular vein, satisfactory oxygenation of the patient is achieved. In this form, the instituted VV-ECMO enables patient mobility, better physical rehabilitation and facilitates pulmonary extubation and toilet. However, relatively early, after the first short-term reports were published, a relatively high complication rate became evident. In the recent literature, the complication rate using actual commercially available double-lumen venovenous cannula ranges between 5 and 30%. These cases were mostly conjoined to the implantation phase or the early postoperative phase and vary between right heart perforation to migration of the cannula. This review focuses on complications allied to commercially available dual-lumen, single, venovenous cannula implantation, pointing out the critical segments of the implantation process and analyzing the structure of the device.

Sour orange bud regeneration and in vitro plant development related to culture medium composition and explant type

In order to evaluate the formation of adventitious buds and in vitro regeneration of sour orange plants (Citrus aurantium L.) two organogenesis-inducing experiments were conducted. In the first experiment, the induction and in vitro regeneration of adventitious buds were tested on epicotyl and internodal segments under the influence of BAP or KIN associated with NAA. The second experiment evaluated the in vitro regeneration of sour orange plants related to different explant types (epicotyls segments, internodal segments of in vitro germinated plantlets and internodal segments of greenhouse cultivated plants). Data collected on both experiments included the percentage of responsive explants (explants that formed buds), and the number of buds per explant. The addition of BAP showed the best organogenic response. In vitro germinated epicotyl segments and internodal segments are recommended as explants for sour orange in vitro organogenesis. Rooting of regenerated shoots was achieved without the need of auxin in the medium.

Fatal Cervical Spine Injury From Diving Accident.

Spinal cord injuries result after diving into shallow water, often after incautious jumps head first into water of unknown depth during recreational or sport activities. Mortality is generally due to upper cervical trauma. The authors present a case of a diving-related death in a young woman who underwent medicolegal investigations. The measured water depth at the supposed dive site was 1.40 m. Postmortem radiology and autopsy revealed fractures of the body and the posterior arch of the fifth cervical vertebra, a fracture of the right transverse process of the sixth cervical vertebra and hemorrhages involving the cervical paraspinal muscles. Neuropathology showed a posterior epidural hematoma involving the whole cervical region and a symmetric laceration of the spinal cord located at the fourth and fifth cervical vertebra level, surrounded by multiple petechial hemorrhages. Toxicology revealed the presence of ethanol in both blood and urine samples. The death was attributed to cervical spine fracture (C5-C6), spinal cord contusion, and subsequent drowning. This case highlights the usefulness of postmortem radiology, examination of the deep structures of the neck, toxicology, neuropathology, and a detailed research of signs of drowning to formulate appropriate hypotheses pertaining to the cause and mechanism of death.

Tietämyksen hallinta ja tietopääoma liiketoiminnassa – case ABC-liikennemyymäläketju

Tässä tutkimuksessa tutkittiin tietämyksen hallintaa, tietopääomaa ja niiden ilmentymiä liiketoiminnassa. Tutkimuksen avulla pyrittiin selvittämään, pystytäänkö tutkimukseen valittujen mallien avulla määrittelemään S-ryhmään kuuluvan ABC-liikennemyymäläketjun liiketoiminnan kannalta oleellinen tietämyksen hallinta ja tietopääoma. Tutkimus toteutettiin case-tutkimuksena puolistrukturoiduilla teemahaastatteluilla. Haastatteluja tehtiin yhteensä 13 kappaletta. Analyysi, tulokset ja johtopäätökset perustuivat tutkimuksen tekijän omiin tulkintoihin, jotka perustuivat haastatteluista saatujen havaintojen vertailusta teoriaan ja muihin sivutietolähteisiin. Tutkimus osoitti, että tietämyksen hallinnan ja tietopääoman määrittely kyettiin tekemään, mutta lopputulos ei ollut lähtökohtamallin mukainen. Itse määrittelyprosessi ei ollut helppo toteuttaa, mikä johtui tietämyksen hallinnan ja tietopääoman eri osa-alueiden laajuudesta, päällekkäisyydestä, käsitteiden ja aihepiirin vieraudesta haastateltaville. Tutkimuksen oleellisin tulos oli se, että lähtökohtamalliin tehtiin muutoksia tietopääoman osa-alueelle: 1. aineettomaan varallisuuteen lisättiin ”organisaatio” ja poistettiin ”tekniset järjestelmät”, 2. organisaation osaamiseen lisättiin ”verkosto-osaaminen” ja 3. organisaation uudistumiskykyyn lisättiin ”operatiivinen kyvykkyys”. Keskeisin johtopäätös oli, että määritelläkseen liiketoiminnalle ominaisen tietämyksen hallinnan ja tietopääoman ilmentymät, tulee organisaation lähteä liikkeelle yhdestä mallista ja sopia yhteisistä käytettävistä käsitteistä. Organisaatiot ovat eri toimialoilta, joten kaikkia ilmentymiä ei välttämättä esiinny tai löytyy mallissa esiintymättömiä ilmentymiä. Tällöin tulee tehdä muutoksia lähtökohtakohtamalliin.

Search Interfaces on the Web: Querying and Characterizing

Current-day web search engines (e.g., Google) do not crawl and index a significant portion of theWeb and, hence, web users relying on search engines only are unable to discover and access a large amount of information from the non-indexable part of the Web. Specifically, dynamic pages generated based on parameters provided by a user via web search forms (or search interfaces) are not indexed by search engines and cannot be found in searchers’ results. Such search interfaces provide web users with an online access to myriads of databases on the Web. In order to obtain some information from a web database of interest, a user issues his/her query by specifying query terms in a search form and receives the query results, a set of dynamic pages that embed required information from a database. At the same time, issuing a query via an arbitrary search interface is an extremely complex task for any kind of automatic agents including web crawlers, which, at least up to the present day, do not even attempt to pass through web forms on a large scale. In this thesis, our primary and key object of study is a huge portion of the Web (hereafter referred as the deep Web) hidden behind web search interfaces. We concentrate on three classes of problems around the deep Web: characterization of deep Web, finding and classifying deep web resources, and querying web databases. Characterizing deep Web: Though the term deep Web was coined in 2000, which is sufficiently long ago for any web-related concept/technology, we still do not know many important characteristics of the deep Web. Another matter of concern is that surveys of the deep Web existing so far are predominantly based on study of deep web sites in English. One can then expect that findings from these surveys may be biased, especially owing to a steady increase in non-English web content. In this way, surveying of national segments of the deep Web is of interest not only to national communities but to the whole web community as well. In this thesis, we propose two new methods for estimating the main parameters of deep Web. We use the suggested methods to estimate the scale of one specific national segment of the Web and report our findings. We also build and make publicly available a dataset describing more than 200 web databases from the national segment of the Web. Finding deep web resources: The deep Web has been growing at a very fast pace. It has been estimated that there are hundred thousands of deep web sites. Due to the huge volume of information in the deep Web, there has been a significant interest to approaches that allow users and computer applications to leverage this information. Most approaches assumed that search interfaces to web databases of interest are already discovered and known to query systems. However, such assumptions do not hold true mostly because of the large scale of the deep Web – indeed, for any given domain of interest there are too many web databases with relevant content. Thus, the ability to locate search interfaces to web databases becomes a key requirement for any application accessing the deep Web. In this thesis, we describe the architecture of the I-Crawler, a system for finding and classifying search interfaces. Specifically, the I-Crawler is intentionally designed to be used in deepWeb characterization studies and for constructing directories of deep web resources. Unlike almost all other approaches to the deep Web existing so far, the I-Crawler is able to recognize and analyze JavaScript-rich and non-HTML searchable forms. Querying web databases: Retrieving information by filling out web search forms is a typical task for a web user. This is all the more so as interfaces of conventional search engines are also web forms. At present, a user needs to manually provide input values to search interfaces and then extract required data from the pages with results. The manual filling out forms is not feasible and cumbersome in cases of complex queries but such kind of queries are essential for many web searches especially in the area of e-commerce. In this way, the automation of querying and retrieving data behind search interfaces is desirable and essential for such tasks as building domain-independent deep web crawlers and automated web agents, searching for domain-specific information (vertical search engines), and for extraction and integration of information from various deep web resources. We present a data model for representing search interfaces and discuss techniques for extracting field labels, client-side scripts and structured data from HTML pages. We also describe a representation of result pages and discuss how to extract and store results of form queries. Besides, we present a user-friendly and expressive form query language that allows one to retrieve information behind search interfaces and extract useful data from the result pages based on specified conditions. We implement a prototype system for querying web databases and describe its architecture and components design.

Aineettomien pääomaerien tunnistaminen ja hyväksikäyttö strategiatyössä

Tässä tutkimuksessa tutkittiin keinoja tunnistaa organisaation aineeton pääoma ja yhdistää se strategiatyöhön. Aineettomien pääomien tunnistamisen yhteydessä tutkittiin myös sitä, miten on mahdollista tunnistaa juuri strategisesti merkittävät aineettomat pääomat. Tutkimuksen teoreettinen osuus toteutettiin kirjallisuuskatsauksena. Tutkimuksen empiirinen osuus toteutettiin case-tutkimuksena käyttäen menetelminä osallistuvaa havainnointia kahden työpajan aikana ja kyselylomaketta. Tutkimus oli haasteellinen toteuttaa johtuen aihe-alueen laajuudesta ja teorioiden päällekkäisyydestä sekä aihepiirin vieraudesta tutkimukseen osallistuneille. Analyysi, tulokset ja johtopäätökset perustuivat tutkijan omiin tulkintoihin. Tulkintoja tehtiin analysoimalla case-tutkimuksen aikana kerättyjä aineistoja ja vertaamalla case-tutkimuksen tuloksia teoriaan. Case-tutkimus osoitti, että aineettoman pääoman tunnistamisen ja strategiaan yhdistämisen tueksi tarvitaan toimivia työkaluja. Huolimatta toimivistakin työkaluista, on aineettoman pääoman erien tunnistaminen haastavaa eikä ydinkompetenssien tunnistaminen välttämättä onnistu täysin objektiivisesti. Myös aineettoman pääoman yhdistäminen strategiaan on aiemmin asiaan perehtymättömälle vaikeaa. Tutkimus todisti, että aineettoman pääoman rakenteen ja hyväksikäytön tutkimusta tulee jatkaa jotta voidaan kehittää toimivia ja helppokäyttöisiä työkaluja aineettoman pääoman johtamisen tueksi.

Biomechanical Changes During a 50-minute Run in Different Footwear and on Various Slopes.

The effects of footwear and inclination on running biomechanics over short intervals are well documented. Although recognized that exercise duration can impact running biomechanics, it remains unclear how biomechanics change over time when running in minimalist shoes and on slopes. Our aims were to describe these biomechanical changes during a 50-minute run and compare them to those observed in standard shoes. Thirteen trained recreational male runners ran 50 minutes at 65% of their maximal aerobic velocity on a treadmill, once in minimalist shoes and once in standard shoes, 1 week apart in a random order. The 50-minute trial was divided into 5-minute segments of running at 0%, +5%, and -5% of treadmill incline sequentially. Data were collected using photocells, high-speed video cameras, and plantar-pressure insoles. At 0% incline, runners exhibited reduced leg stiffness and plantar flexion angles at foot strike and lower plantar pressure at the forefoot and toes in minimalist shoes from minute 34 of the protocol onward. However, only reduced plantar pressure at the toes was observed in standard shoes. Overall, similar biomechanical changes with increased exercise time were observed on the uphill and downhill inclines. The results might be due to the unfamiliarity of subjects to running in minimalist shoes.

Bilateral breast swelling secondary to superior vena cava obstruction and subclavian vein thrombosis

Superior vena cava syndrome is defined by a set of signs and symptoms secondary to superior vena cava obstruction caused principally by malignant diseases. The present report describes the case of an unusual clinical manifestation of this syndrome with bilateral breast swelling, and emphasizes the relevance of knowledge on mammographic signs of systemic diseases.

Hyperechoic breast lesions: anatomopathological correlation and differential sonographic diagnosis

Abstract Hyperechoic lesions are not a frequent finding at breasts ultrasonography, and most of times are associated with benign pathologies that do not require further evaluation. However, some neoplasms such as invasive breast carcinomas and metastases may present with hyperechogenicity. Thus, the knowledge about differential diagnoses and identification of signs of lesion aggressiveness are of great relevance to avoid unnecessary procedures or underdiagnosis, and to support the correct clinical/surgical approach. On the basis of such concepts, the present essay describes and illustrates the main features of hyperechoic lesions at breast ultrasonography in different cases, with anatomopathological correlation.

Tuotannon kehitysinvestointiprojektien läpivientimalli

Tämän diplomityön tarkoituksena oli tutkia ja etsiä kehityskohteita kohdeyrityksen kehitysinvestointiprojektien toimintamallissa. Diplomityön tavoitteena oli tutkia nykyistä investointikäytäntöä ja luoda eri linjastoissa tehtäville kehitysinvestointiesityksille edellytykset tukea yhteisesti yrityksen tulevia suhdannenäkymiä ja strategiaa. Työn tavoitteena oli myös pyrkiä välillisesti kasvattamaan investointiin sijoitettavan pääoman tuottoprosenttia pienentämällä kustannuksia huolellisen valmistelun keinoin jo investointiprojektin kehityksen alkuvaiheessa. Työkaluksi tähän todettiin olevan läpivientimalli. Tutkimusmenetelminä käytettiin kvantitatiivisia ja kvalitatiivisia tiedonkeruumenenelmiä. Näistä ylemmän johdon ja keskijohdon haastattelut, sekä omat kokemukset yrityksen käytännöistä vuosilta 2004-2008 näyttelivät pääroolia. Työn tuotoksena laadittiin aiheeseen liittyvä ohjeistus ja läpivientimalli osaksi yrityksen laatujärjestelmää. Malli sijoitettiin template tyyppisesti dokumentinhallinnointiohjelmistoon. Työn tuloksena on esitetty kehitysinvestointiprojektien läpivientimalli siten, että se tukee yrityksen strategiaa kestävän kehityksen ympäröimänä. Työlle asetetut tavoitteet saavutettiin sille tarkoitetussa aikavälissä.

Desafios da química analítica frente às necessidades da indústria farmacêutica

The development of liquid chromatography-mass spectrometric (LC-MS) techniques in the last few decades has made possible the analysis of trace amounts of analytes from complex matrices. With LC, the analytes of interest can be separated from each other as well as from the interfering matrix, after which they can be reliably identified thanks to the sensitivity and specificity of MS. LC-MS has become an irreplaceable tool for many applications, ranging from the analysis of proteins or pharmaceuticals in biological fluids to the analysis of toxic substances in environmental samples. In different segments of Brazilian Industry mass spectrometry has an important role, e.g. in the pharmaceutical industry in the development of generic formulations, contributing to the growth of Industry and social inclusion. However, the Brazilian chemists until this moment don't have an effective role in this new segment of the analytical chemistry in Brazil. The present paper shows the actual scenario for mass spectrometry in the pharmaceutical industry, emphasizing the need of a revision of graduation courses to attend the needs of this growing market.

Estratégia supramolecular para a nanotecnologia

Brazilian science is evolving rapidly and steadly in the last 10 years, reaching the 15º place in the international ranking. Research in nanotechnology is following a similar way generating new scientific and technological knowledge in several frontiers but specially in the interfaces of two or more areas, where Chemistry is consolidating itself as a central science. In this context, the supramolecular approach is a very promissing one because it allows the build-up of a chemical inteligence using all the sistematized knowledge for the design and development of new nanomaterials and products. The great challenge of Chemistry is not decrease the dimensionality of the materials but instead find ways to increase the dimensionality and structural complexity keeping strict control on the interactions between the components, in order to generate materials with new properties and functionalities. Unfortunately, the current vigorous advancement of scientific research has not been followed by the transformation of such know-how into patents and produts. Therefore much efforts should be devoted to build a national science and technology program, joining all the segments of the society involved in the technological development (university, institutes of technological research, industry and government) in order to promote the furtherance of the Brazilian technological base. Only in this way it is possible to evolve to a technological society capable to transform the scientific knowledge into wealthy, thus sustaining the socioeconomic development of the country.

Síndrome de estenose pilórica por adenocarcinoma de piloro

We present a case of primary malignant pylorus neoplasia, emphasizing its rarity, the difficulty of diagnosis and the importance of an adequate prepare before the endoscopic procedure. Literature shows that tumors compromising the first, third and fourth segments of duodenum are rare, especially those of the pyloric area, representing only 0.35% of all malignant tumors of the gastrointestinal tract. Adenocarcinoma is the most common histological type, representing 50% of all malignant neoplasias at this site. The most common symptoms are weight loss, nausea, vomiting, abdominal pain, abdominal mass, sudden changes in intestinal habits and iron deficiency anemia secondary to chronic intestinal hemorrhage. Survival after five years is only 18%. We report a case of a seventy-one year-old male referring early satiety, epigastric pain, retrosternal burning and dyspepsia, with unspecific results in complementary exams, since complete gastric emptying was not achieved. As symptoms worsened, the patient was submitted to laparotomy, with identification of gastric dilation and severe pyloric stenosis, macroscopically suggesting malignancy. The chosen procedure was a subtotal gastrectomy. Adjuvant radiotherapy and chemotherapy were not used. The patient is been followed-up without tumor recurrence so far.

Osaamisen johtaminen pk-yrityksen kansainvälisen kasvun elinkaarella

Tutkimuksen tavoitteena oli osaamisen johtamisen holistinen tarkastelu pk-yrityksen kansainvälisen kasvun elinkaarella. Osaamisen johtamisen malli sisältää osaamisen, tiedon, eriasteiset ja hierarkisesti eritasoiset liittoumat ja verkostot sekä internetin tarjonnan organisaation oppimisen ohella. Pk-yrityksen syntyminen, kasvu kotimarkkinoilla ja kansainvälinen kasvu voivat perustua kansainvälisyyteen. Holistinen kansainvälistyminen voi alkaa mistä funktiosta tai prosessista tahansa ja ulottua eriasteisena muihin funktioihin ja/tai prosesseihin. Kansainvälistyminen ja kansainvälinen toiminta voi katketa kokonaan tai funktioitain ja alkaa uudelleen. Tutkimuksen holistisella mallilla analysoitiin tapausyritykset hyödyntämällä osa-aluekronologiaa. Tuloksilla tarkennettiin mallia. Tarkennettu malli korostaa kasvu ja/tai kansainvälistymisärsykkeen/impulssin syntyvän sekä kotiettä ulkomaisilta kysyntä- ja/tai tarjontamarkkinoilta sekä yrityksen sisä- että ulkopuolelta tai olevan piilevänä omistajayrittäjässä. Holistisuus korostaa mallin kaikissa osissa ennen alkua (pre-start) vaiheen asemaa, päättymätöntä uudistumisprosessia. Osaamisen johtamisessa korostuu proaktiivisuus. Jokainen uudistamisprosessi edellyttää olevan osaamisen vahvistamista, ja organisaation ulkopuolisen osaamis- ja tietopääoman hyödyntämistä. Osaamisen johtaminen sisältää varsinaisen ja laajennetun organisaation yksilöiden, ryhmien ja yksiköiden visio- ja strategiaperusteisen johtamisen. Tämä edellyttää sitouttamista, motivointia ja omaehtoisuuden sekä organisaation sisäisen ja ulkoisen kulttuurietäisyyden hyödyntämistä. Yksilön fokus osaamisen johtamisen näkökulmasta on tehtävään sitoutuminen ja itsensä toteuttaminen. Fokukset ovat proaktiiviisia vaihdellen funktioiden ja prosessien elinkaarilla dynaamisesti. Tutkimus myötävaikuttaa omistajayrittäjän roolin korostamiseen, kasvu- ja kansainvälistymisimpulssin ja ennen alkua (pre start) vaiheen holistisuuden ymmärtämiseen laaja-alaisesti. Kasvu- ja kansainvälistymisimpulsseja/ärsykkeitä ja niistä seuraavia pre start vaiheita/osa-alueita on pk-yrityksen elinkaarella (1+n) kappaletta; (n: 0- oo). Malli myötävaikuttaa ymmärtämään aineettomia osaamis- ja tieto-optioita sekä korostaa transnationalpiirteitä kansainvälistä kasvua vahvistavina.

Customer profitability measurement in a not-for-profit organization

The objective of this study was to find out the factors that affect customer profitability in the not-for-profit case company. The customer profitability was examined in two different segments of the customer base. The effects that price, cost and the amount of services provided have on the profit margin were studied. The distribution of profitability among the customers and the effect of certain characteristics, such as size of the customer measured in services purchased, on the profitability were analyzed. The theoretical framework was built around customer profitability and the use of customer profitability information in a not-for-profit organization. The present use of customer profitability information and the possibilities of using the results of this research in the case company were presented. Quantitative research methods were used in the empirical part of the study. The results indicate that the two customer segments have differences in their buying behaviors which affect the profitability and thus the measures taken to improve the profitability should be considered with the different characteristics of the customers in mind. Finally the limitations of the study were discussed as possible further research topics.