Cesarean section - short term maternal complications related to the mode of delivery

Cesarean section (CS) is the most common major surgery performed on women worldwide. CS can save the life of the mother or the fetus, but is associated with the typical complications of any major surgery: hemorrhage, infection, venous thromboembolism and complications of anesthesia, sometimes leading to maternal death. Recently there have been several reports from well resourced countries on increased severe maternal morbidity and even mortality. Increased rates of CS, obesity and older mothers may explain this rise. The aim of this thesis is to study the rates and risk factors of short term maternal complications associated with CS. Also, we compared maternal morbidity by mode of delivery and over time. The complication rates were assessed in a prospective study involving 2496 CS performed in the 12 largest delivery units in Finland in 2005. The rates of severe complications were studied by mode of delivery in a register-based study comparing national cohorts in 1997 and 2002. The impact of several risk factors on severe maternal morbidity by mode of delivery was studied in a register-based study of all singleton deliveries in 2007-2011. In the prospective study, 27% of the women who underwent CS had one or more intraoperative or postoperative complications during their hospital stay, and 10% had a severe complication. In the register-based study the incidence of life-threatening maternal complications was 7.6 in 1000 deliveries. The incidence was lowest for vaginal delivery (VD), followed by instrumental VD and elective CS, and highest in emergency CS. An attempt of VD, including the risks associated with emergency CS, seems to be the safest mode of delivery, even for most high-risk women.

Intima-media thickness evaluation by B-mode ultrasound: Correlation with blood pressure levels and cardiac structures

The aim of this study was to analyze the thickness of the intima-media complex (IMC) using a noninvasive method. The carotid and femoral common arteries were evaluated by noninvasive B-mode ultrasound in 63 normotensive and in 52 hypertensive subjects and the thickness of the IMC was tested for correlation with blood pressure, cardiac structures and several clinical and biological parameters. The IMC was thicker in hypertensive than in normotensive subjects (0.67 ± 0.13 and 0.62 ± 0.16 vs 0.54 ± 0.09 and 0.52 ± 0.11 mm, respectively, P<0.0001). In normotensive patients, the simple linear regression showed significant correlations between IMC and age, body mass index and 24-h systolic blood pressure for both the carotid and femoral arteries. In hypertensives the carotid IMC was correlated with age and 24-h systolic blood pressure while femoral IMC was correlated only with 24-h diastolic blood pressure. Forward stepwise regression showed that age, body mass index and 24-h systolic blood pressure influenced the carotid IMC relationship (r2 = 0.39) in normotensives. On the other hand, the femoral IMC relationship was influenced by 24-h systolic blood pressure and age (r2 = 0.40). In hypertensives, age and 24-h systolic blood pressure were the most important determinants of carotid IMC (r2 = 0.37), while femoral IMC was influenced only by 24-h diastolic blood pressure (r2 = 0.10). There was an association between carotid IMC and echocardiographic findings in normotensives, while in hypertensives only the left posterior wall and interventricular septum were associated with femoral IMC. We conclude that age and blood pressure influence the intima-media thickness, while echocardiographic changes are associated with the IMC.

L'expérience comme mode de détermination des faits dans le procès civil

L'utilisation de l'expérience comme un mode de détermination des faits, c'est-à-dire comme un élément qui comble les lacunes dans l'ensemble des éléments de preuve dans le procès civil, est un thème quelque peu tabou. La doctrine est souvent basée sur la prémisse voulant que le décideur rende une décision uniquement en vertu des éléments de preuve et qu'il doit absolument s'abstenir d'insérer aux constatations quoi que ce soit qui n'est pas présent dans les éléments de preuve. Cette vision est éloignée de la réalité juridique. Dans la première partie, nous allons aborder les principes procéduraux qui empêchent l'utilisation de l'expérience comme mode de détermination des faits. Ce sont le principe de la reconstruction de l'événement du passé, le principe de l'abstraction des connaissances acquises hors du procès et le principe de l'exclusion de la preuve par ouï-dire. Ensuite, nous portons notre attention sur les différents types d'expérience, c'est-à-dire l'expérience profane, divisible en bon sens et sens commun, et l'expérience scientifique, ainsi sur leurs modes de fonctionnement dans le procès civil. La première partie se termine par une brève confrontation des différents types d'expérience avec les principes procéduraux. La deuxième partie est consacré à l'analyse de l'expérience dans trois instruments juridiques: la connaissance d'office, la présomption de fait et le témoignage d'expert. Nous nous intéressons principalement à vérifier si l'expérience fonctionne à l'intérieur de ces instruments juridiques comme mode de détermination des faits et ensuite quelles sont les limites que le droit pose à l'expérience dans ce rôle. L'analyse va confirmer que le principal instrument par lequel l'expérience comme mode de détermination des faits pénètre dans le procès civil est la présomption de fait.

Travail en mode projet distribué géographiquement : mesure des compétences, de la collaboration et des performances individuelles selon le degré de virtualité

Dans un contexte où le monde du travail s’internationalise et où l’innovation est fondamentale, les organisations d’aujourd’hui doivent structurer le travail en tenant compte des distances géographiques et du besoin de bien performer dans les tâches reliées aux différents projets. Toutefois, le recours à des projets innovants et l’accès à des moyens de communication ne sont pas des conditions suffisantes pour assurer une performance adéquate. Différents facteurs, comme les compétences adaptées au travail virtuel et le degré de virtualité qui sépare les gens, doivent être pris en compte pour favoriser l’atteinte d’une bonne performance. De plus, afin de sélectionner les candidats qui seront en mesure de bien performer dans ce contexte, le recours à des outils d’évaluation appropriés et disponibles dans plusieurs langues est essentiel. Cette thèse présente en premier lieu un processus de traduction, d’adaptation et de validation en français et en anglais d’un outil en allemand visant l’évaluation des compétences requises lorsque le travail est organisé en mode distribué. Un premier article présente les limites fréquemment observées dans les études qui effectuent de telles adaptations. Un deuxième article met ensuite en lumière l’importance relative d’un ensemble de compétences liées à deux types de performances individuelles appropriées au travail en projet virtuel. Les résultats montrent que la créativité, l’autonomie, l’intégrité, la loyauté et la minutie sont directement liées à la performance proactive. Il est cependant nécessaire de prendre en compte l’effet positif de la perception de collaboration et l’effet négatif du degré de virtualité pour comprendre comment les compétences que constituent la motivation à apprendre, l’autonomie, l’intégrité, la loyauté et la minutie agissent sur la performance adaptative. En somme, cette thèse propose d’abord un processus rigoureux permettant l’adaptation, la traduction et la validation d’outils dans plusieurs langues. Ce processus permet d’éviter les limites auxquelles se buteraient des méthodes plus simples dans un contexte international où il est primordial d’avoir une très grande confiance en l’équivalence des instruments. Cette thèse représente également un avancement intéressant en ce qui a trait à la compréhension des différents déterminants de la performance individuelle lorsque le travail est organisé en projets virtuels. Des recommandations sont présentées afin de favoriser la performance individuelle, et des pistes de recherches futures sont également amenées pour continuer à approfondir les connaissances sur le sujet.

La grammaire de soi ; l’enquête psychanalytique, un mode d’organisation des interactions propre aux sociétés démocratiques contemporaines

Une multitude de gens, au XXe siècle, se sont servis de la psychanalyse pour se rendre compte de leurs faits et gestes. En s’appuyant ainsi sur la psychanalyse, ils démontraient la profondeur de la confiance qu’ils lui accordaient. Cette diffusion ample et profonde, qui a laissé une empreinte très marquée sur la culture contemporaine, demeure largement inexpliquée. Ce phénomène étonnant devient intelligible dès lors qu’on aborde la psychanalyse comme une grammaire de l’intériorité, qui a guidé des interactions en les médiatisant par des symboles et des significations communes (normes, valeurs, etc.) propres aux sociétés démocratiques contemporaines (celles qui se conçoivent comme émanant d’un accord entre individus). Cette pratique sociale, l’enquête psychanalytique, peut être analysée en situant dans leurs contextes d’interactions les discours dans lesquels des désirs refoulés étaient imputés à différentes conduites. L’œuvre de Freud offre un échantillon de tels discours. La description de la forme et du sens que ces imputations de désirs refoulés conféraient à différentes interactions en cours nous permet d’identifier les traits caractéristiques de l’enquête psychanalytique. Freud montre que le refoulement naît d’un conflit entre une volonté présociale refoulée et une volonté socialisée, refoulante, née des exigences inculquées par l’autorité parentale. Pour identifier un désir refoulé, il faut donc simultanément identifier une relation refoulante. L’enquête psychanalytique amène à passer en revue les différentes relations interpersonnelles et intrapersonnelles dans lesquelles est impliqué l’auteur du refoulement. Cet exercice permet de départager les relations qui contraignent la volonté intérieure présociale à des exigences sociales de celles qui, en sens inverse, émanent de cette volonté intérieure. Comme les premières suscitent le refoulement et les symptômes indésirables qu’il entraîne, la guérison du refoulement exige que le porteur du refoulement prenne ses distances des exigences sociales héritées, de manière à parvenir à reconnaître sa volonté présociale. En soupesant ainsi la contrainte exercée sur les volontés présociales par les relations particulières, l’enquête psychanalytique jaugeait ces dernières à partir d’une exigence propre aux sociétés démocratiques contemporaines : celle de fonder les relations sociales sur les volontés non contraintes des partenaires. L’enquête psychanalytique participait ainsi d’un imaginaire social moderne qui donnait, à des relations variées, la forme d’un contrat. Les contemporains qui recouraient à cette enquête manifestaient un souci de respecter cette exigence et ils suscitaient une réaction critique envers les relations qui contraignaient la volonté. En somme, l’enquête psychanalytique offrait aux contemporains une manière d’ordonner les relations qui était adaptée à une société accordant une autorité prééminente aux exigences « contractuelles ». Voilà qui explique en grande partie l’ampleur et la profondeur de la diffusion de la psychanalyse au XXe siècle.

RNS based programmable multi-mode decimation filter for WCDMA and WiMAX

The recent trends envisage multi-standard architectures as a promising solution for the future wireless transceivers to attain higher system capacities and data rates. The computationally intensive decimation filter plays an important role in channel selection for multi-mode systems. An efficient reconfigurable implementation is a key to achieve low power consumption. To this end, this paper presents a dual-mode Residue Number System (RNS) based decimation filter which can be programmed for WCDMA and 802.16e standards. Decimation is done using multistage, multirate finite impulse response (FIR) filters. These FIR filters implemented in RNS domain offers high speed because of its carry free operation on smaller residues in parallel channels. Also, the FIR filters exhibit programmability to a selected standard by reconfiguring the hardware architecture. The total area is increased only by 24% to include WiMAX compared to a single mode WCDMA transceiver. In each mode, the unused parts of the overall architecture is powered down and bypassed to attain power saving. The performance of the proposed decimation filter in terms of critical path delay and area are tabulated.

Dual-mode RNS based programmable decimation filter for WCDMA and WLANa

The recent trends envisage multi-standard architectures as a promising solution for the future wireless transceivers. The computationally intensive decimation filter plays an important role in channel selection for multi-mode systems. An efficient reconfigurable implementation is a key to achieve low power consumption. To this end, this paper presents a dual-mode Residue Number System (RNS) based decimation filter which can be programmed for WCDMA and 802.11a standards. Decimation is done using multistage, multirate finite impulse response (FIR) filters. These FIR filters implemented in RNS domain offers high speed because of its carry free operation on smaller residues in parallel channels. Also, the FIR filters exhibit programmability to a selected standard by reconfiguring the hardware architecture. The total area is increased only by 33% to include WLANa compared to a single mode WCDMA transceiver. In each mode, the unused parts of the overall architecture is powered down and bypassed to attain power saving. The performance of the proposed decimation filter in terms of critical path delay and area are tabulated

Model Calculations and Implementation of Filters and Hybrid Green VCSELs based on Optical Thin Film Stacks

This work introduced the novel conception of complex coupled hybrid VCSELs for the first time. Alternating organic and inorganic layers in the lasers provide periodic variation of refractive index and optical gain, which enable single mode operation and low threshold of the VCSELs. Model calculations revealed great reduction of the lasing threshold with factors over 30, in comparison with the existing micro-cavity lasers. Tunable green VCSEL has been also designed, implemented and analyzed taking advantage of the broad photoluminescence spectra of the organics. Free standing optical thin films without compressive stress are technologically implemented. Multiple membrane stacks with air gap in between have been fabricated for the implementation of complex coupled VCSEL structures. Complex coupled hybrid VCSEL is a very promising approach to fill the gaps in the green spectral range of the semiconductor lasers.

Advances in sequential data assimilation and numerical weather forecasting: an Ensemble Transform Kalman-Bucy Filter, a study on clustering in deterministic Ensemble Square Root Filters, and a test of a new time stepping scheme in an atmospheric model

This dissertation deals with aspects of sequential data assimilation (in particular ensemble Kalman filtering) and numerical weather forecasting. In the first part, the recently formulated Ensemble Kalman-Bucy (EnKBF) filter is revisited. It is shown that the previously used numerical integration scheme fails when the magnitude of the background error covariance grows beyond that of the observational error covariance in the forecast window. Therefore, we present a suitable integration scheme that handles the stiffening of the differential equations involved and doesn’t represent further computational expense. Moreover, a transform-based alternative to the EnKBF is developed: under this scheme, the operations are performed in the ensemble space instead of in the state space. Advantages of this formulation are explained. For the first time, the EnKBF is implemented in an atmospheric model. The second part of this work deals with ensemble clustering, a phenomenon that arises when performing data assimilation using of deterministic ensemble square root filters in highly nonlinear forecast models. Namely, an M-member ensemble detaches into an outlier and a cluster of M-1 members. Previous works may suggest that this issue represents a failure of EnSRFs; this work dispels that notion. It is shown that ensemble clustering can be reverted also due to nonlinear processes, in particular the alternation between nonlinear expansion and compression of the ensemble for different regions of the attractor. Some EnSRFs that use random rotations have been developed to overcome this issue; these formulations are analyzed and their advantages and disadvantages with respect to common EnSRFs are discussed. The third and last part contains the implementation of the Robert-Asselin-Williams (RAW) filter in an atmospheric model. The RAW filter is an improvement to the widely popular Robert-Asselin filter that successfully suppresses spurious computational waves while avoiding any distortion in the mean value of the function. Using statistical significance tests both at the local and field level, it is shown that the climatology of the SPEEDY model is not modified by the changed time stepping scheme; hence, no retuning of the parameterizations is required. It is found the accuracy of the medium-term forecasts is increased by using the RAW filter.

Stratosphere‐troposphere coupling and annular mode variability in chemistry‐climate models

The internal variability and coupling between the stratosphere and troposphere in CCMVal‐2 chemistry‐climate models are evaluated through analysis of the annular mode patterns of variability. Computation of the annular modes in long data sets with secular trends requires refinement of the standard definition of the annular mode, and a more robust procedure that allows for slowly varying trends is established and verified. The spatial and temporal structure of the models’ annular modes is then compared with that of reanalyses. As a whole, the models capture the key features of observed intraseasonal variability, including the sharp vertical gradients in structure between stratosphere and troposphere, the asymmetries in the seasonal cycle between the Northern and Southern hemispheres, and the coupling between the polar stratospheric vortices and tropospheric midlatitude jets. It is also found that the annular mode variability changes little in time throughout simulations of the 21st century. There are, however, both common biases and significant differences in performance in the models. In the troposphere, the annular mode in models is generally too persistent, particularly in the Southern Hemisphere summer, a bias similar to that found in CMIP3 coupled climate models. In the stratosphere, the periods of peak variance and coupling with the troposphere are delayed by about a month in both hemispheres. The relationship between increased variability of the stratosphere and increased persistence in the troposphere suggests that some tropospheric biases may be related to stratospheric biases and that a well‐simulated stratosphere can improve simulation of tropospheric intraseasonal variability.

Southern annular mode dynamics in observations and models, Part I: The influence of climatological zonal wind biases in a comprehensive GCM

A common bias among global climate models (GCMs) is that they exhibit tropospheric southern annular mode (SAM) variability that is much too persistent in the Southern Hemisphere (SH) summertime. This is of concern for the ability to accurately predict future SH circulation changes, so it is important that it be understood and alleviated. In this two-part study, specifically targeted experiments with the Canadian Middle Atmosphere Model (CMAM) are used to improve understanding of the enhanced summertime SAM persistence. Given the ubiquity of this bias among comprehensive GCMs, it is likely that the results will be relevant for other climate models. Here, in Part I, the influence of climatological circulation biases on SAM variability is assessed, with a particular focus on two common biases that could enhance summertime SAM persistence: the too-late breakdown of the Antarctic stratospheric vortex and the equatorward bias in the SH tropospheric midlatitude jet. Four simulations are used to investigate the role of each of these biases in CMAM. Nudging and bias correcting procedures are used to systematically remove zonal-mean stratospheric variability and/or remove climatological zonal wind biases. The SAM time-scale bias is not alleviated by improving either the timing of the stratospheric vortex breakdown or the climatological jet structure. Even in the absence of stratospheric variability and with an improved climatological circulation, the model time scales are biased long. This points toward a bias in internal tropospheric dynamics that is not caused by the tropospheric jet structure bias. The underlying cause of this is examined in more detail in Part II of this study.

Southern annular mode dynamics in observations and models, Part II: Eddy feedbacks

Many global climate models (GCMs) have trouble simulating Southern Annular Mode (SAM) variability correctly, particularly in the Southern Hemisphere summer season where it tends to be too persistent. In this two part study, a suite of experiments with the Canadian Middle Atmosphere Model (CMAM) is analyzed to improve our understanding of the dynamics of SAM variability and its deficiencies in GCMs. Here, an examination of the eddy-mean flow feedbacks is presented by quantification of the feedback strength as a function of zonal scale and season using a new methodology that accounts for intraseasonal forcing of the SAM. In the observed atmosphere, in the summer season, a strong negative feedback by planetary scale waves, in particular zonal wavenumber 3, is found in a localized region in the south west Pacific. It cancels a large proportion of the positive feedback by synoptic and smaller scale eddies in the zonal mean, resulting in a very weak overall eddy feedback on the SAM. CMAM is deficient in this negative feedback by planetary scale waves, making a substantial contribution to its bias in summertime SAM persistence. Furthermore, this bias is not alleviated by artificially improving the climatological circulation, suggesting that climatological circulation biases are not the cause of the planetary wave feedback deficiency in the model. Analysis of the summertime eddy feedbacks in the CMIP-5 models confirms that this is indeed a common problem among GCMs, suggesting that understanding this planetary wave feedback and the reason for its deficiency in GCMs is key to improving the fidelity of simulated SAM variability in the summer season.

Objective Empirical Mode Decomposition metric

Empirical Mode Decomposition (EMD) is a data driven technique for extraction of oscillatory components from data. Although it has been introduced over 15 years ago, its mathematical foundations are still missing which also implies lack of objective metrics for decomposed set evaluation. Most common technique for assessing results of EMD is their visual inspection, which is very subjective. This article provides objective measures for assessing EMD results based on the original definition of oscillatory components.

Mode, senmodernitet, identitet

Fashion, late modernity and identity A common discussion in the late modern era is the role that tradition plays concerning individual identity. This forms a background to our article that focuses on consumer culture and one of its characteristics – fashion. To what extent does consumer culture and fashion contribute to the undermining of traditions, and how does this affect individual identity? We discuss two interpretations of consumption in shaping individual identity: the first interpretation maintains that by consumption individuals obtain an increasing freedom of choicemaking them free from the power of tradition, and thereby responsible for their lifestyle choices. According to the second interpretation, the free choice is illusory. This choiceis strongly influenced by factors such as social class and producers’ manipulative skills. Contrasting classical social theorists with contemporary fashion theory we argue that late modern fashion is characterized by quick changes and pluralism that often stand in contrast to tradition. We further discuss the increased importance of taste and new diffusion patterns as signs of a more individualized fashion, and discuss neo-tribalism as a post-traditional kind of community.

The establishment mode choise of German multinational enterprises in Brazil: a comparative approach

We examine the drivers behind the establishment mode choice of German multinational enterprises (MNEs) in the sectors of Automotive, Chemicals and Mechanical Engineering in Brazil for the years 1993-2013 using a novel sample of primary data obtained directly from German MNEs. Based on prevalent theories found in the literature, we test the most common hypotheses on our sample. Firms with high R&D activities and firms with prior market knowledge in Brazil in from of previous sales offices are more likely to enter Brazil by a Greenfield investment. We also show that it is the specific private ownership of the German so-called hidden champions that drive those specific SMEs to enter Brazil by Greenfield, a sneaking suspicion that has been made before. Finally, we show that the establishment mode choice between Brazil and the USA only deviates to a low extent, with German MNEs preferring to enter Brazil by Greenfield and the USA by M&A. Thereby, we provide valuable insights for future research in this field.