Reliability and validity of a Portuguese version of the Young Mania Rating Scale

The reliability and validity of a Portuguese version of the Young Mania Rating Scale were evaluated. The original scale was translated into and adapted to Portuguese by the authors. Definitions of clinical manifestations, a semi-structured anchored interview and more explicit rating criteria were added to the scale. Fifty-five adult subjects, aged 18 to 60 years, with a diagnosis of Current Manic Episode according to DSM-III-R criteria were assessed using the Young Mania Rating Scale as well as the Brief Psychiatric Rating Scale in two sessions held at intervals from 7 to 10 days. Good reliability ratings were obtained, with intra-class correlation coefficient of 0.97 for total scores, and levels of agreement above 0.80 (P < 0.001) for all individual items. Internal consistency analysis resulted in an alpha = 0.67 for the scale as a whole, and an alpha = 0.72 for each standardized item (P < 0.001). For the concurrent validity, a correlation of 0.78 was obtained by the Pearson coefficient between the total scores of the Young Mania Rating Scale and Brief Psychiatric Rating Scale. The results are similar to those reported for the English version, indicating that the Portuguese version of the scale constitutes a reliable and valid instrument for the assessment of manic patients.

Integrating corporate social responsibility into business in Finnish consumer goods companies

The motives for this study originated from the notion that surprisingly little academic literature is found on actually managing and putting corporate social responsibility (CSR) into practice, in comparison with the definitions and frameworks of the concept itself. Regardless of the author, CSR has been considered consisting of three dimensions: economic, social and environmental. The question behind the three dimensions has always been whether socially and environmentally responsible behavior can lead to increased economic performance and improve the competitiveness of a company. Most of the current CSR development has related to the quantification of environmental and social performance in order to review these along with the established financial key ratios, which are based on the law and the reporting obligation of the companies. However, the previous research has mainly focused on US companies whereas studies with a European viewpoint, let alone Nordic, have been mostly lacking. Furthermore, it has been discovered recently that the integration of corporate responsibility into business is identified as the greatest challenge in CSR management in Finnish large companies. Therefore the integration of CSR into business in Finnish consumer goods companies provided an interesting, topical and somewhat obscure purpose for this study. This was further divided into three research questions concerning the reasons for CSR engagement, the role of the stakeholders and the practice of corporate responsibility. This study did not aim to build a new theory; instead an explorative viewpoint was regarded more appropriate. Accordingly, qualitative research approach and case study design were adopted in the study. Semi-structured theme interviews were used as a primary data collection method and complemented with secondary data such as websites, responsibility reports and another recent CSR study. There were four Finnish managers as interviewees of whom three presented companies and one non-profit organization. The results were somewhat convergent but differences arose as a result of the companies being at different stages as regards corporate responsibility. However, this provided only more insight into the implementation of CSR. The voluntary CSR initiatives, responsibility reporting, stakeholders and CSR management were identified as the most important viewpoints on the practical side of CSR, besides a key requirement for the integration of CSR into business to be credible was found to be a favorable management attitude. Based on the findings of this study it was admitted that giving concrete advice on CSR management is really a challenge and there is no one generally accepted and right manner to integrate corporate responsibility successfully into business.

A systematic mapping study on technical debt definition

The goal of this study was to explore and understand the definition of technical debt. Technical debt refers to situation in a software development, where shortcuts or workarounds are taken in technical decision. However, the original definition has been applied to other parts of software development and it is currently difficult to define technical debt. We used mapping study process as a research methodology to collect literature related to the research topic. We collected 159 papers that referred to original definition of technical debt, which were retrieved from scientific literature databases to conduct the search process. We retrieved 107 definitions that were split into keywords. The keyword map is one of the main results of this work. Apart from that, resulting synonyms and different types of technical debt were analyzed and added to the map as branches. Overall, 33 keywords or phrases, 6 synonyms and 17 types of technical debt were distinguished.

Novel word learning ability in chronic post-stroke aphasia : variability and modality effects

Novel word learning has been rarely studied in people with aphasia (PWA), although it can provide a relatively pure measure of their learning potential, and thereby contribute to the development of effective aphasia treatment methods. The main aim of the present thesis was to explore the capacity of PWA for associative learning of word–referent pairings and cognitive-linguistic factors related to it. More specifically, the thesis examined learning and long-term maintenance of the learned pairings, the role of lexical-semantic abilities in learning as well as acquisition of phonological versus semantic information in associative novel word learning. Furthermore, the effect of modality on associative novel word learning and the neural underpinnings of successful learning were explored. The learning experiments utilized the Ancient Farming Equipment (AFE) paradigm that employs drawings of unfamiliar referents and their unfamiliar names. Case studies of Finnishand English-speaking people with chronic aphasia (n = 6) were conducted in the investigation. The learning results of PWA were compared to those of healthy control participants, and active production of the novel words and their semantic definitions was used as learning outcome measures. PWA learned novel word–novel referent pairings, but the variation between individuals was very wide, from more modest outcomes (Studies I–II) up to levels on a par with healthy individuals (Studies III–IV). In incidental learning of semantic definitions, none of the PWA reached the performance level of the healthy control participants. Some PWA maintained part of the learning outcomes up to months post-training, and one individual showed full maintenance of the novel words at six months post-training (Study IV). Intact lexical-semantic processing skills promoted learning in PWA (Studies I–II) but poor phonological short-term memory capacities did not rule out novel word learning. In two PWA with successful learning and long-term maintenance of novel word–novel referent pairings, learning relied on orthographic input while auditory input led to significantly inferior learning outcomes (Studies III–IV). In one of these individuals, this previously undetected modalityspecific learning ability was successfully translated into training with familiar but inaccessible everyday words (Study IV). Functional magnetic resonance imaging revealed that this individual had a disconnected dorsal speech processing pathway in the left hemisphere, but a right-hemispheric neural network mediated successful novel word learning via reading. Finally, the results of Study III suggested that the cognitive-linguistic profile may not always predict the optimal learning channel for an individual with aphasia. Small-scale learning probes seem therefore useful in revealing functional learning channels in post-stroke aphasia.

Study of the advancement of innovations in communications industry. Case study: Russian Post Company

This study attempted to provide a project based on the already tested and successful results of foreign business which can help to contain the final price of innovation on desired levels. The research will attempt to dig out most of available information related to aforementioned definitions and thus completing theoretical background. Next author will explain used methodology and the process of evidence collection. After that the study will show the analysis of collected data in order to obtain results which are going to be compared with stated objectives in the final part. The conclusion of the research and proposed possibilities for additional work will be given in the last part. For this study author has chosen the qualitative model because it performs very well for analysis of small scale of data. The case study method was used because it gave author an opportunity to make an in-depth analysis of the collected information about particular organization so it became possible to analyze system's details in comparison. The results have been early considered valid and applicable to other studies. As the result thesis has proposed undertakings which reflect researches aimed on solving problems with provision of services and development of communications. In addition thesis has proposed formulation of database of postal service for Russian Post when (by request) customer possess an account where he or she can access postal services via PC or info table in postal office and order delivery of postal products which will be given private identification code. Project's payoff period has been calculated as well.

p16INK4 expression in precursor lesions of squamous cell cervical cancer related to the presence of HPV-DNA

The purpose of the present study was to identify the expression of p16INK4 in cervical cancer precursor lesions by immunohistochemistry and to correlate it with lesion grade and presence of human papillomavirus (HPV) infection. Cervical specimens from 144 women seen consecutively at the gynecology outpatient clinic of our institution from December 2003 to May 2005 were analyzed by cytopathology, histopathology, polymerase chain reaction for HPV-DNA, and p16INK4 immunostaining. Histologically normal biopsies, HPV-DNA negative by polymerase chain reaction, were used as control. HPV-DNA prevalence, including the control group, was 68.1% and the prevalence of p16INK4 expression was 55.0%. The percentage of cells stained by p16INK4 ranged from 10 to 100%, both in the group consisting of cervical intraepithelial neoplasia (CIN)1/HPV specimens and in the group of CIN2/CIN3 specimens with P value of 0.0001. p16INK4 expression was 48.3% in the CIN1/HPV group, as opposed to 94.3% in the CIN2/CIN3 group (P = 0.001), showing a statistically significant difference between the two groups. The quantitative method used here is simple and less subjective than the different semiquantitative methods described in the literature. In view of the different definitions of a p16INK4-positive case, it is almost impossible to compare the findings reported by different investigators. This study confirms the association between p16INK4 and CIN2 and CIN3 lesions. Moreover, it shows that some low grade lesions expressed high levels of this protein. This may indicate that such low grade lesions may be predisposed to progress to high grade lesions. This means that p16INK4 may be a strong marker for "neoplastic lesions" induced by HPV and not just an infection marker.

Prevalence of metabolic syndrome and its association with educational inequalities among Brazilian adults: a population-based study

The present study estimated the prevalence of metabolic syndrome (MS) according to the criteria established by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) and the International Diabetes Federation (IDF) and analyzed the contribution of social factors in an adult urban population in the Southeastern region of Brazil. The sample plan was based on multistage probability sampling according to family head income and educational level. A random sample of 1116 subjects aged 30 to 79 years was studied. Participants answered a questionnaire about socio-demographic variables and medical history. Fasting capillary glucose (FCG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides were determined and all non-diabetic subjects were submitted to the 75-g oral glucose tolerance test. Body mass index (BMI, kg/m²), waist circumference and blood pressure (BP) were determined. Age- and gender-adjusted prevalence of MS was 35.9 and 43.2% according to NCEP-ATPIII and IDF criteria, respectively. Substantial agreement was found between NCEP-ATPIII and IDF definitions. Low HDL-C levels and high BP were the most prevalent MS components according to NCEP-ATPIII criteria (76.3 and 59.2%, respectively). Considering the diagnostic criteria adopted, 13.5% of the subjects had diabetes and 9.7% had FCG ≥100 mg/dL. MS prevalence was significantly associated with age, skin color, BMI, and educational level. This cross-sectional population-based study in the Southeastern region of Brazil indicates that MS is highly prevalent and associated with an important social indicator, i.e., educational level. This result suggests that in developing countries health policy planning to reduce the risk of MS, in particular, should consider improvement in education.

Mistä on hyvät tytöt tehty? Somalitytöt ja maineen merkitykset

Tutkimus käsittelee islaminuskoisten somalityttöjen hyvään ja huonoon maineeseen liittyviä uskonnollisia, kulttuurisia ja etnisiä määrittelyjä ja niiden merkityksiä heidän arjessaan. Turussa hankittu etnografinen tutkimusaineisto koostuu osallistuvaan havainnointiin perustuvasta kenttäpäiväkirja-aineistosta sekä kahdestakymmenestäviidestä 17‒35-vuotiaiden somalityttöjen ja -naisten teemahaastattelusta vuosilta 2003–2006. Tutkimuksen tehtävänä on selvittää, minkälaista somalityttöä pidetään maineeltaan hyvänä ja miten tytön maine voi mennä. Tutkimuksessa tarkastellaan yhtäältä sitä, mikä merkitys sosiaalisilla verkostoilla on tyttöjen maineen määrittelyssä. Toisaalta kysytään, mitä somalitytöt ja nuoret naiset itse ajattelevat tytön maineeseen liittyvistä odotuksista ja miten he niistä tietoisina toimivat. Lähestymistapa rakentuu uskontotieteen, antropologian, sukupuolentutkimuksen, tyttötutkimuksen, nuorisotutkimuksen ja kulttuurimaantieteen näkökulmia yhdistelemällä. Ensimmäisessä aineistontulkintaluvussa tarkastellaan tyttöyteen ja maineen rakentumiseen liittyvää ruumiillista merkityksenantoa pukeutumisen, seksuaalisuuden, tyttöjen ympärileikkausta koskevan asennemuutoksen ja seurustelun teemojen kautta. Toisessa luvussa keskitytään kaupunkitilan ja tyttöjen vapaa-ajanvieton sosiotilallisiin tulkintoihin sekä tyttöjen käytöstä kodin ulkopuolella määritteleviin ja mainetta rakentaviin puheisiin. Haastatellut arvostivat islamiin ja somaliperinteeseen liittyviä arvoja ja pitivät niitä oman käytöksensä ohjenuorina. Omanarvontunto, itsekontrolli ja vastuuntunto omista teoista liitettiin ”hyvään tyttöyteen”. Tyttöjen toimijuus ilmeni heihin kohdistuvien odotusten suuntaisena käyttäytymisenä ja näiden ihanteiden arvostamisena. Toimijuus näkyi myös tiettyjen tyttöihin ja poikiin kohdistuvien erilaisten odotusten kyseenalaistamisena ja joissakin tapauksissa vastoin odotuksia toimimisena. Turkua myös verrattiin somalityttöjen käytöksen osalta pääkaupunkiseutuun. Tässä vertailussa Turku nimettiin kulttuurisen jatkuvuuden, pääkaupunkiseutu kulttuurisen muutoksen paikaksi. Haastateltujen mukaan yhteisöllisiä tulkintoja tyttöjen käytöksestä tehtiin puheissa ja juoruissa, usein suhteessa havaintoihin suomalaistyttöjen käytöksestä. Tyttöjen arkeen nämä etniset ja moraaliset eroteot eivät kuitenkaan vaikuttaneet aina samalla tavoin, koska tulkinnat tyttärille sopivasta ja mahdollisesta käytöksestä voivat vaihdella perheiden välillä. Tutkimus tuo esille, että tytön hyvä maine on eräs perheen hyvinvointiin vaikuttavista tekijöistä. Somalityttöjen käytös on myös eräs yhteisöllinen peili, jota vasten tehdään laajempia tulkintoja somalikulttuurin ja uskonnollisten arvojen tilasta diasporassa. Liiallinen muutos tyttöjen käyttäytymisessä uhkasi yhteisöllistä jatkuvuutta ja uskonnolliskulttuuristen arvojen välittymistä seuraaville sukupolville. Laajasti ymmärrettynä ”hyvä tyttöys” ja hyvä maine oli onnistuneen kulttuurisen neuvottelun tulosta diasporassa. Se tarkoitti, että tyttö kiinnittyi somalialaiseen taustaansa ja sen välittämiin arvoihin, osallistuen samalla kuitenkin myös suomalaiseen yhteiskuntaan.

Non-Markovian dynamics in quantum optical dephasing channels

Quantum computation and quantum communication are two of the most promising future applications of quantum mechanics. Since the information carriers used in both of them are essentially open quantum systems it is necessary to understand both quantum information theory and the theory of open quantum systems in order to investigate realistic implementations of such quantum technologies. In this thesis we consider the theory of open quantum systems from a quantum information theory perspective. The thesis is divided into two parts: review of the literature and original research. In the review of literature we present some important definitions and known results of open quantum systems and quantum information theory. We present the definitions of trace distance, two channel capacities and superdense coding capacity and give a reasoning why they can be used to represent the transmission efficiency of a communication channel. We also show derivations of some properties useful to link completely positive and trace preserving maps to trace distance and channel capacities. With the help of these properties we construct three measures of non-Markovianity and explain why they detect non-Markovianity. In the original research part of the thesis we study the non-Markovian dynamics in an experimentally realized quantum optical set-up. For general one-qubit dephasing channels we calculate the explicit forms of the two channel capacities and the superdense coding capacity. For the general two-qubit dephasing channel with uncorrelated local noises we calculate the explicit forms of the quantum capacity and the mutual information of a four-letter encoding. By using the dynamics in the experimental implementation as a set of specific dephasing channels we also calculate and compare the measures in one- and two-qubit dephasing channels and study the options of manipulating the environment to achieve revivals and higher transmission rates in superdense coding protocol with dephasing noise. Kvanttilaskenta ja kvanttikommunikaatio ovat kaksi puhutuimmista tulevaisuuden kvanttimekaniikan käytännön sovelluksista. Koska molemmissa näistä informaatio koodataan systeemeihin, jotka ovat oleellisesti avoimia kvanttisysteemejä, sekä kvantti-informaatioteorian, että avointen kvanttisysteemien tuntemus on välttämätöntä. Tässä tutkielmassa käsittelemme avointen kvanttisysteemien teoriaa kvantti-informaatioteorian näkökulmasta. Tutkielma on jaettu kahteen osioon: kirjallisuuskatsaukseen ja omaan tutkimukseen. Kirjallisuuskatsauksessa esitämme joitakin avointen kvanttisysteemien ja kvantti-informaatioteorian tärkeitä määritelmiä ja tunnettuja tuloksia. Esitämme jälkietäisyyden, kahden kanavakapasiteetin ja superdense coding -kapasiteetin määritelmät ja esitämme perustelun sille, miksi niitä voidaan käyttää kuvaamaan kommunikointikanavan lähetystehokkuutta. Näytämme myös todistukset kahdelle ominaisuudelle, jotka liittävät täyspositiiviset ja jäljensäilyttävät kuvaukset jälkietäisyyteen ja kanavakapasiteetteihin. Näiden ominaisuuksien avulla konstruoimme kolme epä-Markovisuusmittaa ja perustelemme, miksi ne havaitsevat dynamiikan epä-Markovisuutta. Oman tutkimuksen osiossa tutkimme epä-Markovista dynamiikkaa kokeellisesti toteutetussa kvanttioptisessa mittausjärjestelyssä. Yleisen yhden qubitin dephasing-kanavan tapauksessa laskemme molempien kanavakapasiteettien ja superdense coding -kapasiteetin eksplisiittiset muodot. Yleisen kahden qubitin korreloimattomien ympäristöjen dephasing-kanavan tapauksessa laskemme yhteisen informaation lausekkeen nelikirjaimisessa koodauksessa ja kvanttikanavakapasiteetin. Käyttämällä kokeellisen mittajärjestelyn dynamiikkoja esimerkki dephasing-kanavina me myös laskemme konstruoitujen epä-Markovisuusmittojen arvot ja vertailemme niitä yksi- ja kaksi-qubitti-dephasing-kanavissa. Lisäksi käyttäen kokeellisia esimerkkikanavia tutkimme, kuinka ympäristöä manipuloimalla superdense coding –skeemassa voidaan saada yhteinen informaatio ajoittain kasvamaan tai saavuttaa kaikenkaikkiaan korkeampi lähetystehokkuus.

Aspectos clínicos da doença renal policística autossômica recessiva DRPAR

INTRODUÇÃO: A Doença Renal Policística Autossômica Recessiva (DRPAR) é uma causa importante de morbidade e mortalidade pediátricas, com um espectro variável de manifestações clínicas. MÉTODOS: A apresentação e evolução clínica de 25 pacientes (Pts) foram analisadas através da revisão de prontuários, aplicando-se os formulários propostos por Guay-Woodford et al. As morbidades associadas à doença foram avaliadas quanto à frequência e à idade de manifestação. RESULTADOS: A idade média de diagnóstico foi de 61,45 meses (0 a 336,5 meses), com distribuição similar entre os sexos (52% dos pts do sexo feminino). Houve histórico familiar da doença em 20% dos casos (5/25), com dois casos de consanguinidade. Na análise inicial, diagnosticou-se hipertensão arterial (HAS) em 56% dos Pts (14/25); doença renal crônica estágio > 2 (DRC > 2) em 24% (6/25); infecções do trato urinário (ITU) em 40% (10/25) e hipertensão portal (HP) em 32% dos casos (8/25). Das ultrassonografias abdominais iniciais, 80% demonstraram rins ecogênicos com cistos grosseiros e 64% detectaram fígado e vias biliares normais. Inibidores da ECA foram utilizados em 36% dos Pts, betabloqueadores em 20%, bloqueadores de canais de cálcio em 28% e diuréticos em 36% dos casos. Na análise final, após um tempo de acompanhamento médio de 152,2 meses (29,8 a 274,9 meses), HAS foi diagnosticada em 76% dos Pts, DRC > 2 em 44%, ITU em 52% e HP em 68%. CONCLUSÃO: As altas morbidade e mortalidade associadas à DRPAR justificam a construção de um banco de dados internacional, visando ao estabelecimento de um tratamento de suporte precoce.

O uso de vacinas na profilaxia das infecções do trato urinário

O trato urinário é o sítio mais comum de infecção bacteriana. As infecções do trato urinário (ITU) recorrentes em mulheres sem anormalidades anatômicas do trato urinário demandam uso frequente e repetido de antibióticos, aumentando a prevalência de micro-organismos resistentes aos antimicrobianos. A possibilidade de abordagem alternativa, com a utilização de vacinas produzidas a partir de bactérias inativadas ou componentes estruturais desses micro-organismos, é uma realidade palpável. Confirmando resultados observados experimentalmente, estudos clínicos controlados têm mostrado redução dos episódios de recorrência, sem efeitos colaterais significativos, com imunoterapia oral ou vaginal. Nesta revisão, foram apresentados os mecanismos de agressão e defesa envolvidos na gênese das infecções urinárias em mulheres com trato urinário normal, a evolução do conhecimento sobre a imunoterapia nas ITU e as vacinas já disponíveis ou em desenvolvimento para o tratamento dessa importante condição clínica.

Infecção urinária comunitária: etiologia segundo idade e sexo

INTRODUÇÃO: A escolha do antimicrobiano para tratamento inicial de infecção de trato urinário (ITU) costuma ser empírica e deve considerar a prevalência dos uropatógenos nas diversas faixas etárias e sexo. OBJETIVO: Avaliar a prevalência de uropatógenos em ITU comunitária e sua relação com idade e sexo. MÉTODOS: Estudo transversal conduzido em pronto socorro (PS) de hospital geral, de janeiro a dezembro, 2010, em pacientes menores de 15 anos com suspeita clínica de ITU, que colheram urocultura quantitativa. Definida ITU como urocultura com crescimento de agente único > 100.000 unidades formadoras de colônia (ufc)/mL na coleta por jato médio ou > 50.000 ufc/mL na coleta por sondagem vesical. RESULTADOS: Ocorreram 63.464 atendimentos no PS. Foram obtidas 2.577 uroculturas; destas, 291 foram positivas para ITU (prevalência = 11,3% das suspeitas clínicas e 0,46% dos atendimentos); 212 casos (72,8%) em meninas, mediana de idade = 2,6 anos. O uropatógeno predominante foi E.coli (76,6%), seguido por Proteus mirabilis (10,3%) e Staphylococcus saprophyticus (4,1%). Em lactentes < 3 meses, a prevalência de E.coli foi significativamente menor (50% x 78,4%; OR = 0,276; p = 0,006). Maior prevalência de Staphylococcus saprophyticus ocorreu em pacientes > 10 anos (24,4% x 0,4%; OR = 79,265; p < 0,0001). Proteus mirabilis foi significativamente mais prevalente em meninos (24,0% x 5,2%; OR = 5,786; p < 0,001). CONCLUSÕES: E. coli foi o uropatógeno mais prevalente das ITU comunitárias. Entretanto, na escolha do antimicrobiano empírico inicial, deve-se levar em consideração a prevalência significativa de outros agentes diferentes de E. coli em lactentes < 3 meses, a alta prevalência de Staphylococcus saprophyticus em pacientes > 10 anos e de Proteus mirabilis em meninos.

Impacto de uma abordagem interdisciplinar em crianças e adolescentes com disfunção do trato urinário inferior (DTUI)

Introdução: A disfunção do trato urinário inferior (DTUI) corresponde a alterações no enchimento ou esvaziamento de urina de causas neurogênicas, anatômicas e funcionais. Objetivo: Avaliar o impacto do tratamento em crianças e adolescentes com DTUI. Métodos: Coorte histórica de 15 anos de seguimento com participação de 192 pacientes (123F, 69M) com idade inicial de 0,1 a 16,8 anos, analisados à admissão (T0) e ao final do seguimento (T1). A maioria dos pacientes era do grupo neurológico (60,4%). O tratamento instituído foi a uroterapia com intervenção comportamental e cognitiva, micção de hora marcada, hidratação oral, dieta laxativa, biofeedback, eletroestimulação sacral, cateterismo vesical intermitente limpo (CIL), terapia anticolinérgica, enema retal, tratamento da infecção do trato urinário (ITU) e, nos casos refratários, procedimentos cirúrgicos, tais como a derivação urinária continente e incontinente (vesicostomia), ampliação vesical e conduto para a realização do enema anterógrado cólico. Resultados: Os principais sintomas foram incontinência urinária diurna (82,3%), enurese noturna não monossintomática (78,6%), incontinência fecal (54,2%) e constipação intestinal (47,9%). Detectou-se redução significativa da infecção do trato urinário (p = 0,0027), da incontinência urinária diurna (p < 0,001), da enurese noturna (p < 0,001), da incontinência fecal (p = 0,010) e do refluxo vesicoureteral (p = 0,01). Houve aumento significativo no uso do CIL (p = 0,021), da terapia com anticolinérgico (p < 0,001) e diminuição da quimioprofilaxia (p < 0,001). Conclusão: Este estudo mostrou que o tratamento da DTUI na criança deve ser individualizado, além de requerer uma monitorização constante dos parâmetros clínicos, laboratoriais e de imagem, para minimizar o risco de lesão renal.

Uso de Eculizumab na síndrome hemolítica urêmica atípica após transplante renal

Descrever uso do Eculizumab na síndrome hemolítica urêmica atípica (SHUa) após transplante renal. Paciente de 16 anos, com diagnóstico de doença renal crônica desde 2010, decorrente de SHUa, submetida à hemodiálise. Transplante renal por doador falecido: fevereiro de 2012. Apresentou boa evolução clínica até 14º DPO, quando iniciou quadro de febre, oligúria, piora da função renal [creatinina sérica (CRs): 4,0 mg/dl] e sinais de hemólise [plaquetas: 110.000 mm3; hemoglobina (Hb): 4,5 g/dL; LDH: 3366 U/L]. Biópsia do enxerto: microangiopatia trombótica. Realizado manejo com hemoderivados (plasma fresco) e plasmaférese, com melhora da função renal (CRs: 1,46 mg/dl). Uma semana após esta intercorrência, reapresentou quadro de febre, anemia, sinais de hemólise e ITU, então manejados com ciprofloxacina, pulsoterapia com metilprednisolona e transfusão de plasma (plaquetas: 43.000 mm3; Hb: 6,0 mg/dl, reticulócitos: 1,3%, haptoglobina < 5,8 mg/dl, LDH: 1181 U/L). Após piora clínica, iniciada terapêutica com Eculizumab, 900 mg a cada cinco dias durante duas semanas. Evoluiu com boa resposta clínica, caracterizada pela melhora da função renal, normalização hematológica (plaquetas: 160.000 mm3; Hb: 11,4 g/dL) e alta hospitalar em cinco dias. Desde então, mantém uso de Eculizumab 900 mg de 15/15 dias, com quadro renal e hematológico estável. O uso de Eculizumab foi de grande utilidade no controle da recidiva da SHUa e preservação do enxerto.

Sotilassovelluksissa käytettävät vaimenemismallit VHF-taajuusalueella

Radioaalloilla on rajallinen kantama. Tämän kantaman rajallisuus johtuu radioaaltojen vaimenemisesta yhteysvälillä etäisyyden ja esteiden vaikutuksesta. VHF-taajuusalueella (30–300 MHz) radioaaltojen eteneminen tapahtuu pääosin näköyhteysreittiä, minkä vuoksi niiden vaimenemista pystytään ennustamaan tyydyttävällä tarkkuudella. Vaimenemisen ennustamiseen on käytössä kehittyneitä ohjelmistosovelluksia, kuten ranskalainen HTZ re -ohjelmisto, mutta yleisluontoinen työväline karkeaan mallintamiseen puuttuu. Tutkielmassa selvitetään kirjallisuuskatsauksen avulla mitkä ulkoiset tekijät vaikuttavat VHF-vastaanottimelle saapuvan signaalin voimakkuuteen, esitellään radioaaltojen etenemiseen liittyviä peruskäsitteitä sekä kuvataan esimerkki mahdollisuudesta yksinkertaisella tavalla mallintaa yhteysväli maastokartan perusteella. Tutkielmassa esitetään valikoitu määrä sotilassovelluksissa käytettyjä yleisimpiä vaimenemismalleja kuten vapaan tilan eteneminen, kahden säteen eteneminen sekä esteiden vaimennuksen ennustamiseen käytettävä veitsenterämalli. Lisäksi esitetään yleisimpiä yhteysvälin kokonaisvaimenemisen ennustamiseen käytettyjä laskentametodeja kuten Kansainvälisen televiestintäliiton (ITU) diffraktiomalli ja HTZ Warfare -ohjelmistoon varta vasten luotu ns. Fresnelin metodi. Tutkielmassa kuvataan matemaattisen mallinnuksen ja kolmen laskuesimerkin avulla, kuinka vertailuun valikoidut kokonaisvaimenemisen ennustamismetodit tuottavat toisistaan poikkeavia arvioita sekä selvitetään, mistä nämä erot johtuvat. Laskuesimerkkien tulosten perusteella havaittiin eri laskentametodien tuottavan suuresti toisistaan poikkeavia ennusteita. Tämä johtuu muun muassa mallien erilaisista painotuksista antennien korkeuden huomioimisessa sekä erilaisesta tavasta käsitellä yhteysvälin esteitä. Samassa yhteydessä havaittiin, että mikään vertailluissa malleista ei itsessään ota huomioon taajuuden nostamisen aiheuttamaa kasvuston vaimennuksen kasvamista. Kirjallisuuskatsauksen perusteella ITU:n suositusasiakirjoilla on vakiintunut asema vaimenemisen mallintamisessa ja niitä hyödyntäessään käyttäjällä on tukenaan laajan tiedeyhteisön vertaisarvioitu tutkimus. Myös HTZ Warfare -ohjelmiston Fresnelin metodin on yksittäisissä Suomessa suoritetuissa mittaustutkimuksissa havaittu tuottavan hyviä tuloksia. Kokonaisuudessaan tutkielmassa havaittiin, että yksi malli ei sovellu kaikkeen. Tämän vuoksi mallinnusta suorittavan on syytä tuntea erilaisten mallien toimintaperiaatteet ja niistä aiheutuvat mahdolliset rajoitteet. Ymmärryksen lisäämisen ohella yksinkertaisten mallien tunteminen mahdollistaa niiden soveltamisen toimintaolosuhteissa, joissa varsinaisia mallinnusohjelmistoja ei jostain syystä ole käytettävissä. Työn ohessa esitetty taulukkolaskentapohja ohjaa käyttäjäänsä ja mahdollistaa yksinkertaisten vaimenemismallien avulla laskemisen maastokartan tarjoamilla pohjatiedoilla. Taulukkolaskentasovellus sisältyy tutkielman CD-ROM-julkaisuun.