Sobrecarga de ferro transfusional em portadores de anemia falciforme: comparação entre ressonância magnética e ferritina sérica

OBJETIVO: Identificar variáveis preditoras de sobrecarga de ferro em portadores de anemia falciforme e correlacionar indicadores bioquímicos e imaginológicos. MATERIAiS E MÉTODOS: Foi realizado estudo transversal envolvendo 32 portadores de anemia falciforme, que foram submetidos a dosagem sérica de ferro, ferritina e a ressonância magnética do fígado. Foram realizadas cinco sequências gradiente-eco e uma spin-eco. A intensidade de sinal foi obtida em cada sequência pelas médias das regiões de interesse no fígado e musculatura paravertebral para obter a razão da intensidade de sinal (RIS) fígado/músculo. A partir da RIS foi obtida a concentração hepática estimada de ferro (CHEF) pela fórmula: e[5,808 - (0,877 × T2*) - (1,518 × PI)], onde T2* é a RIS na sequência com TE de 13 ms e PI é a RIS da sequência com ponderação intermediária. Os pacientes foram agrupados segundo o regime de transfusão de hemácias (regulares mensais versus esporádicas). RESULTADOS: Os grupos transfusionais foram comparados pelas variáveis clínico-laboratoriais, sendo significativas as diferenças entre RIS, CHEF e ferritina sérica: o grupo que recebeu transfusões regulares apresentou sobrecarga de ferro hepático mais intensa. CONCLUSÃO: A ressonância magnética foi ferramenta eficiente para avaliação de sobrecarga hepática de ferro em portadores de anemia falciforme.

Malformações do sistema nervoso central e malformações associadas diagnosticadas pela ultrassonografia obstétrica

OBJETIVO: Identificar a prevalência de malformações congênitas do sistema nervoso central (SNC) e malformações associadas diagnosticadas pela ultrassonografia obstétrica. MATERIAIS E MÉTODOS: Estudo observacional, transversal, descritivo, em instituição de referência para gestações de alto risco. RESULTADOS: Malformações congênitas do SNC estiveram presentes sem outras malformações associadas em 65,78%, com a distribuição: hidrocefalia (37,5%), mielomeningocele (15%), encefalocele (12,5%), agenesia de corpo caloso (12,5%), anencefalia (12,5%), holoprosencefalia (7,5%), Dandy-Walker (7,5%), Arnold-Chiari (5,0%), hidranencefalia (5,0%), meningocele (5,0%), cisto aracnoideo (2,5%). Malformações congênitas de outros sistemas estiveram associadas às do SNC: craniofacial (73,9%), ortopédica (65,2%), cardiovascular (34,8%), geniturinária (30,4%), gastrintestinal (30,4%), respiratória (8,7%), sindrômica (8,7), oftalmológica (4,3%). A sensibilidade ultrassonográfica no estudo de malformações fetais do SNC foi 79,4%. A taxa de falso-negativos foi 20,5%. Dentre as limitações quantificáveis destaca-se o oligodrâmnio, presente em 25% dos falso-negativos. CONCLUSÃO: A ultrassonografia obstétrica possui boa sensibilidade no rastreio de malformações fetais do SNC, em especial com o aperfeiçoamento constante e domínio na utilização de métodos especializados, como o Doppler e a ultrassonografia volumétrica (3D/4D), contribuindo para firmar-se como modalidade de escolha nesta rotina. Complementar ao método, a ressonância magnética pode vir a fornecer subsídios para uma ainda melhor assistência perinatal.

Concurs d'idees per a la reforma i ampliació del "Colegio de Arquitectos de Córdoba"

Award-winning

Kuntien vastuulla olevan jätehuollon palvelurakenteen kehittäminen Etelä-Karjalan Jätehuolto Oy:n strategian mukaisesti

Työn tavoitteena on määritellä Etelä-Karjalan Jätehuolto Oy:n toiminta-alueella asumisessa syntyvän jätehuollon palvelutaso muuttunutta jätelainsäädäntöä sekä yhtiön hoidettavaksi siirrettäviä palvelutehtäviä vastaavaksi. Tavoitteena on myös valmistella kunnalliset jätehuoltomääräykset, joilla muutokset pannaan täytäntöön jätehuollon kuljetuksen, keräyksen ja käsittelyn sekä hyötykäyttöön toimittamisen osalta. Tavoitteena on laatia esitys palveluun perustuvasta taksamallista koko toiminta-alueelle. Työn alkuosassa tutustutaan jätelainsäädännön kehittymiseen EU:ssa ja Suomessa sekä valmistelussa oleviin muutoksiin, joilla on vaikutusta jätehuollon suunnittelun ja toteuttamisen kannalta. Tutkitaan miten jätehuoltopalvelut omistajakunnissa on toteutettu ja mitä muutoksia jätelain 10 § ja 13 §:n muutos edellyttää nykyiseen järjestelmään. Työn tuloksena valmistuu maakuntaan asumisen jätehuollon vähimmäispalvelutasoesitys sekä ehdotukset sen kehittämisestä ja kustannusten keräämisestä aiheuttamisperiaatteen mukaisesti alueen yhtenäisillä jätetaksoilla. Jätehuoltomääräysehdotukseen sisällytetään jätehuoltoa koskevat tekniset ja laadulliset vaatimukset sekä keinot, joilla kunnan vastuulla olevia jätteitä saadaan ohjattua hyötykäyttöön.

Mikrokontrolleriohjaus led-ryhmälle

Luonnonvarojen ehtyminen ja ympäristön saastuminen on luonut kysyntää uusille, energiaa säästäville ja ympäristöystävällisille teknologioille. Valaistuksessa tällainen teknologia on led-tekniikka. Led-tekniikalla on useita etuja verrattuna kilpaileviin tekniikoihin kuten pitkä elinikä, ympäristöystävällisyys ja mekaaninen kestävyys. Ledejä käytetään nykyään laajalti erilaisissa erikoissovelluksissa, erityisesti jos vaatimuksena on valon värillisyys. Näihin päiviin asti ledien hinta ja heikko valontuotto ovat rajoittaneet led-valaisimien yleistymistä hehkulamppujen ja muiden valaisintyyppien korvaajina. Tekniikan nopea kehittyminen on tehnyt led-tekniikasta varteenotettavan vaihtoehdon myös yleisvalaistukseen. Uusimpien valkoisten ledien valotehokkuus on 2 - 5 -kertainen hehkulamppuun verrattuna. Led-tekniikassa on vielä paljon käyttämätöntä potentiaalia, tulevaisuudessa päästäneen 10 - 15 -kertaiseen valotehokkuuteen hehkulamppuun verrattuna. Työssä suunnitellaan mikrokontrolleripohjainen ohjausjärjestelmä valkoista valoa tuottavalle led-valaisimelle, jonka värisävyä ja kirkkautta käyttäjä voi säätää. Valkoinen valo synnytetään sekoittamalla neljän erivärisen led-rivin valoa. Mikrokontrolleri ohjaa kutakin led-riviä väriensekoitusteoriaan perustuen. Mikrokontrolleriohjaus huomioi myös ledien optisten ominaisuuksien muutokset lämpötilan suhteen. Mikrokontrolleriohjauksen suorituskyky todetaan käytännön mittauksilla.

ESTRO-HERO survey: Radiotherapy equipment and departments in the European countries: Final results from the ESTRO-HERO survey

Background: Documenting the distribution of radiotherapy departments and the availability of radiotherapy equipment in the European countries is an important part of HERO the ESTRO Health Economics in Radiation Oncology project. HERO has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The aim of the current report is to describe the distribution of radiotherapy equipment in European countries. Methods: An 84-item questionnaire was sent out to European countries, principally through their national societies. The current report includes a detailed analysis of radiotherapy departments and equipment (questionnaire items 2629), analyzed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis is based on validated responses from 28 of the 40 European countries defined by the European Cancer Observatory (ECO). Results: A large variation between countries was found for most parameters studied. There were 2192 linear accelerators, 96 dedicated stereotactic machines, and 77 cobalt machines reported in the 27 countries where this information was available. A total of 12 countries had at least one cobalt machine in use. There was a median of 0.5 simulator per MV unit (range 0.31.5) and 1.4 (range 0.44.4) simulators per department. Of the 874 simulators, a total of 654 (75%) were capable of 3D imaging (CT-scanner or CBCToption). The number of MV machines (cobalt, linear accelerators, and dedicated stereotactic machines) per million inhabitants ranged from 1.4 to 9.5 (median 5.3) and the average number of MV machines per department from 0.9 to 8.2 (median 2.6). The average number of treatment courses per year per MV machine varied from 262 to 1061 (median 419). While 69% of MV units were capable of IMRT only 49% were equipped for image guidance (IGRT). There was a clear relation between socio-economic status, as measured by GNI per capita, and availability of radiotherapy equipment in the countries. In many low income countries in Southern and Central-Eastern Europe there was very limited access to radiotherapy and especially to equipment for IMRT or IGRT. Conclusions: The European average number of MV machines per million inhabitants and per department is now better in line with QUARTS recommendations from 2005, but the survey also showed a significant heterogeneity in the access to modern radiotherapy equipment in Europe. High income countries especially in Northern-Western Europe are well-served with radiotherapy resources, other countries are facing important shortages of both equipment in general and especially machines capable of delivering high precision conformal treatments (IMRT, IGRT)

ESTRO-HERO survey: Radiotherapy staffing in the European countries: Final results from the ESTRO-HERO survey

Background: The ESTRO Health Economics in Radiation Oncology (HERO) project has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The first milestone was to assess the availability of radiotherapy resources within Europe. This paper presents the personnel data collected in the ESTRO HERO database. Materials and methods: An 84-item questionnaire was sent out to European countries, through their national scientific and professional radiotherapy societies. The current report includes a detailed analysis of radiotherapy staffing (questionnaire items 4760), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40 European countries defined by the European Cancer Observatory (ECO). Results: A large variation between countries was found for most parameters studied. Averages and ranges for personnel numbers per million inhabitants are 12.8 (2.530.9) for radiation oncologists, 7.6 (019.7) for medical physicists, 3.5 (012.6) for dosimetrists, 26.6 (1.978) for RTTs and 14.8 (0.461.0) for radiotherapy nurses. The combined average for physicists and dosimetrists is 9.8 per million inhabitants and 36.9 for RTT and nurses. Radiation oncologists on average treat 208.9 courses per year (range: 99.9348.8), physicists and dosimetrists conjointly treat 303.3 courses (range: 85757.7) and RTT and nurses 76.8 (range: 25.7156.8). In countries with higher GNI per capita, all personnel categories treat fewer courses per annum than in less affluent countries. This relationship is most evident for RTTs and nurses. Different clusters of countries can be distinguished on the basis of available personnel resources and socio-economic status. Conclusions: The average personnel figures in Europe are now consistent with, or even more favourable than the QUARTS recommendations, probably reflecting a combination of better availability as such, in parallel with the current use of more complex treatments than a decade ago. A considerable variation in available personnel and delivered courses per year however persists among the highest and lowest staffing levels. This not only reflects the variation in cancer incidence and socio-economic determinants, but also the stage in technology adoption along with treatment complexity and the different professional roles and responsibilities within each country. Our data underpin the need for accurate prediction models and long-term education and training programmes

Guggenheim Helsinki

Postprint (published version)

Passatge Iscle i Molist

Postprint (published version)

PB 123

Postprint (published version)

Alineació

Postprint (published version)

Bio-based composites from stone groundwood applied to new product development

This paper deals with the product design, engineering, and material selection intended for the manufacturing of an eco-friendly chair. The final product is expected to combine design attributes with technical and legal feasibility with the implementation of new bio-based materials. Considering the industrial design, a range of objectives and trends were determined after setting the market requirements, and the final concept was proposed and modeled. The product geometry, production technology, and legal specifications were the input data for product engineering. The material selection was based on the technical requirements. Polypropylene (PP) composite materials based on coupled-fiberglass, sized-fiberglass, and coupled-stone ground wood reinforcements were prepared and characterized. Final formulations based on these PP composites are proposed and justified

Markkinointiviestinnän välittämä imago business-to-business markkinoilla, mielikuvatavoitteena kestävä kehitys

Tässä pro gradu -tutkielmassa tarkasteltiin kansainvälisen metsäteollisuudessa toimivan yrityksen markkinointiviestintää ja sen välittämien imagoviestien siirtymistä business-to-business markkinoilla. Tutkittavat viestit liittyivät kartonkipakkausten kestävän kehityksen ja ympäristöystävällisyyden imagon rakentumiseen. Tutkimuksessa käytettiin kvalitatiivista tutkimusmenetelmää. Tutkimus pohjautui yrityksen teettämän aiemman asiakastutkimuksen aineistoon, jossa selvitettiin pakkauskartonkien mielikuvia kohderyhmässä. Lisäksi tutkittiin imagon viestintää markkinointiviestinnän näkökulmasta. Yrityksen online viestintää verrattiin asiakkaiden vastaavaan viestintään loppukäyttäjille ja selvitettiin siirtyivätkö kestävän kehityksen viestit loppukäyttäjille asti. Tuloksena saatiin osittain yhtenevä viestintä sekä yrityksen asiakkaiden että näiden loppukäyttäjille viestimien teemojen sisällöstä. Tutkimus osoitti, että tärkein viestinnällinen teema on pakkauksen kierrätettävyys. Toisena tärkeänä teemana ilmeni hiilijalanjäljen pienentämisestä viestivät seikat. Nousevana teemana voitiin havaita biohajoavia materiaaleja kohtaan osoitettu kiinnostus. Tutkimuksessa jaettiin vastaajat eri segmentteihin pakkauskartonkien käyttötarkoituksen mukaan ja verrattiin kestävän kehityksen tärkeyttä näiden segmenttien välillä. Segmenteittäin tarkasteltuna suuria eroja ei ollut havaittavissa.

Combining genetic and demographic data for the conservation of a Mediterranean habitat-forming species

The integration of ecological and evolutionary data is highly valuable for conservation planning. However, it has been rarely used in the marine realm, where the adequate design of marine protected areas (MPAs) is urgently needed. Here, we examined the interacting processes underlying the patterns of genetic structure and demographic strucuture of a highly vulnerable Mediterranean habitat-forming species (i.e. Paramuricea clavata (Risso, 1826)), with particular emphasis on the processes of contemporary dispersal, genetic drift, and colonization of a new population. Isolation by distance and genetic discontinuities were found, and three genetic clusters were detected; each submitted to variations in the relative impact of drift and gene flow. No founder effect was found in the new population. The interplay of ecology and evolution revealed that drift is strongly impacting the smallest, most isolated populations, where partial mortality of individuals was highest. Moreover, the eco-evolutionary analyses entailed important conservation implications for P. clavata. Our study supports the inclusion of habitat-forming organisms in the design of MPAs and highlights the need to account for genetic drift in the development of MPAs. Moreover, it reinforces the importance of integrating genetic and demographic data in marine conservation.