Factors affecting the prognosis of Albanian adult patients with generalized tetanus

Background. Despite systematic vaccination of the population, tetanus continues to be a health problem in Albania, as in some other developing countries. In this study, our intent was to evaluate prognostic factors relating to death in adult patients with generalized tetanus. Methodology and patients. All the patients (60) included in the study were hospitalized at the regional hospitals of Shkodra and Korça, and the University Hospital Centre “Mother Theresa” of Tirana, Albania, during the period of 1984-2004. They had a mean age of 49.1+14.4 years, 43 (71.7%) were males and 40 (66.6%) of them lived in rural areas. The mean incubation period was 12 days and the case-fatality rate (CFR) was 38.3%. Results. The CFR in patients with an onset period ≥2 days was 21.7% and in those with <2 days was 48.6%, OR=0.29 (p<0.05). Patients >50 years old had a CFR=60.87% (OR=7, p<0.05). We found the high CFR to be significantly associated with urban residency, male gender, complicated wound, head localization, fever ≥ 38.4 °C, tachycardia > 120 beats/min, and hypertension. Discussion. The main prognostic factor of those analyzed in our study appeared to be the onset period and the age of the patients. We didn’t find significant differences in CFR in patients with different incubation periods. Clinicians must take into account that wound complication and localization, tachycardia and hypertension, high fever, male gender and urban residency significantly influence the prognoses of adults with generalized tetanus.

A generalized model for population dynamics where interactions change over time

La dinámica demográfica ha sido modelada con ecuaciones diferenciales desde que Malthus comenzó sus estudios hace más de doscientos años atrás. Los modelos convencionales siempre tratan relaciones entre especies como estáticas, denotando sólo su dependencia durante un período fijo del tiempo, aunque sea conocido que las relaciones entre especies pueden cambiar con el tiempo. Aquí proponemos un modelo para la dinámica demográfica que incorpora la evolución con el tiempo de las interacciones entre especies. Este modelo incluye una amplia gama de interacciones, de depredador-presa a las relaciones mutualistas, ya sea obligada o facultativa. El mecanismo que describimos permite la transición de una clase de relación entre especies a algún otro, según algunos parámetros externos fijados por el contexto. Estas transiciones podrían evitar la extinción de una de las especies, si esto termina por depender demasiado del ambiente o su relación con las otras especies.

A new construction of Calabi–Yau manifolds: Generalized CICYs

We present a generalization of the complete intersection in products of projective space (CICY) construction of Calabi–Yau manifolds. CICY three-folds and four-folds have been studied extensively in the physics literature. Their utility stems from the fact that they can be simply described in terms of a ‘configuration matrix’, a matrix of integers from which many of the details of the geometries can be easily extracted. The generalization we present is to allow negative integers in the configuration matrices which were previously taken to have positive semi-definite entries. This broadening of the complete intersection construction leads to a larger class of Calabi–Yau manifolds than that considered in previous work, which nevertheless enjoys much of the same degree of calculational control. These new Calabi–Yau manifolds are complete intersections in (not necessarily Fano) ambient spaces with an effective anticanonical class. We find examples with topology distinct from any that has appeared in the literature to date. The new manifolds thus obtained have many interesting features. For example, they can have smaller Hodge numbers than ordinary CICYs and lead to many examples with elliptic and K3-fibration structures relevant to F-theory and string dualities.

A Generalized Methodology to Characterize Composite Materials for Pyrolysis Models

The predictive capabilities of computational fire models have improved in recent years such that models have become an integral part of many research efforts. Models improve the understanding of the fire risk of materials and may decrease the number of expensive experiments required to assess the fire hazard of a specific material or designed space. A critical component of a predictive fire model is the pyrolysis sub-model that provides a mathematical representation of the rate of gaseous fuel production from condensed phase fuels given a heat flux incident to the material surface. The modern, comprehensive pyrolysis sub-models that are common today require the definition of many model parameters to accurately represent the physical description of materials that are ubiquitous in the built environment. Coupled with the increase in the number of parameters required to accurately represent the pyrolysis of materials is the increasing prevalence in the built environment of engineered composite materials that have never been measured or modeled. The motivation behind this project is to develop a systematic, generalized methodology to determine the requisite parameters to generate pyrolysis models with predictive capabilities for layered composite materials that are common in industrial and commercial applications. This methodology has been applied to four common composites in this work that exhibit a range of material structures and component materials. The methodology utilizes a multi-scale experimental approach in which each test is designed to isolate and determine a specific subset of the parameters required to define a material in the model. Data collected in simultaneous thermogravimetry and differential scanning calorimetry experiments were analyzed to determine the reaction kinetics, thermodynamic properties, and energetics of decomposition for each component of the composite. Data collected in microscale combustion calorimetry experiments were analyzed to determine the heats of complete combustion of the volatiles produced in each reaction. Inverse analyses were conducted on sample temperature data collected in bench-scale tests to determine the thermal transport parameters of each component through degradation. Simulations of quasi-one-dimensional bench-scale gasification tests generated from the resultant models using the ThermaKin modeling environment were compared to experimental data to independently validate the models.

Generalized cluster states based on finite groups

We define generalized cluster states based on finite group algebras in analogy to the generalization of the toric code to the Kitaev quantum double models. We do this by showing a general correspondence between systems with CSS structure and finite group algebras, and applying this to the cluster states to derive their generalization. We then investigate properties of these states including their projected entangled pair state representations, global symmetries, and relationship to the Kitaev quantum double models. We also discuss possible applications of these states.

Regional differences of outpatient physician supply as a theoretical economic and empirical generalized linear model

BACKGROUND: Regional differences in physician supply can be found in many health care systems, regardless of their organizational and financial structure. A theoretical model is developed for the physicians' decision on office allocation, covering demand-side factors and a consumption time function. METHODS: To test the propositions following the theoretical model, generalized linear models were estimated to explain differences in 412 German districts. Various factors found in the literature were included to control for physicians' regional preferences. RESULTS: Evidence in favor of the first three propositions of the theoretical model could be found. Specialists show a stronger association to higher populated districts than GPs. Although indicators for regional preferences are significantly correlated with physician density, their coefficients are not as high as population density. CONCLUSIONS: If regional disparities should be addressed by political actions, the focus should be to counteract those parameters representing physicians' preferences in over- and undersupplied regions.

The generating function of the generalized Fibonacci sequence

Using tools of the theory of orthogonal polynomials we obtain the generating function of the generalized Fibonacci sequence established by Petronilho for a sequence of real or complex numbers {Qn} defined by Q0 = 0, Q1 = 1, Qm = ajQm−1 + bjQm−2, m ≡ j (mod k), where k ≥ 3 is a fixed integer, and a0, a1, . . . , ak−1, b0, b1, . . . , bk−1 are 2k given real or complex numbers, with bj #0 for 0 ≤ j ≤ k−1. For this sequence some convergence proprieties are obtained.

Liderazgo y autoeficacia en el comportamiento organizacional positivo

El objetivo que tiene este proyecto es revisar los conceptos básicos acerca de las relaciones que crean los líderes con sus colaboradores dentro de las organizaciones, dichas relaciones y vínculos pueden afectar positiva o negativamente el desempeño de sus actividades diarias dentro de una organización. Para darle inicio a la investigación se estudió como primer paso el concepto de liderazgo transformacional, capital psicológico y que componentes hacían parte de este factor. El desarrollo de la investigación se enfatizó entre el liderazgo transformacional y la autoeficacia ya que son factores claves dentro del desarrollo de las actividades organizacionales debido a que afectan claramente el capital humano de las compañías y están directamente relacionados con el crecimiento de las mismas, lo que nos llevó a preguntarnos ¿qué relación tendrá el liderazgo transformacional y la autoeficacia en la productividad de las empresas? Es aquí donde radica la importancia de esta investigación ya que el cambio de pensamiento de las organizaciones hacia un liderazgo transformacional podría lograr una maximización del desempeño del personal de trabajo en relación al objetivo de la compañía. Como conclusión llegamos a que efectivamente hay un efecto positivo en los individuos que desarrollan un capital psicológico específicamente en el factor de autoeficacia para lograr un desempeño destacable, productivo y eficiente dentro de las organizaciones.

Solvabilty of generalized Hammerstein integral equations on unbounded domains, with sign-changing kernels

In this work we study an Hammerstein generalized integral equation u(t)=∫_{-∞}^{+∞}k(t,s) f(s,u(s),u′(s),...,u^{(m)}(s))ds, where k:ℝ²→ℝ is a W^{m,∞}(ℝ²), m∈ℕ, kernel function and f:ℝ^{m+2}→ℝ is a L¹-Carathéodory function. To the best of our knowledge, this paper is the first one to consider discontinuous nonlinearities with derivatives dependence, without monotone or asymptotic assumptions, on the whole real line. Our method is applied to a fourth order nonlinear boundary value problem, which models moderately large deflections of infinite nonlinear beams resting on elastic foundations under localized external loads.

Delays In Receiving Obstetric Care And Poor Maternal Outcomes: Results From A National Multicentre Cross-sectional Study.

The vast majority of maternal deaths in low-and middle-income countries are preventable. Delay in obtaining access to appropriate health care is a fairly common problem which can be improved. The objective of this study was to explore the association between delay in providing obstetric health care and severe maternal morbidity/death. This was a multicentre cross-sectional study, involving 27 referral obstetric facilities in all Brazilian regions between 2009 and 2010. All women admitted to the hospital with a pregnancy-related cause were screened, searching for potentially life-threatening conditions (PLTC), maternal death (MD) and maternal near-miss (MNM) cases, according to the WHO criteria. Data on delays were collected by medical chart review and interview with the medical staff. The prevalence of the three different types of delays was estimated according to the level of care and outcome of the complication. For factors associated with any delay, the PR and 95%CI controlled for cluster design were estimated. A total of 82,144 live births were screened, with 9,555 PLTC, MNM or MD cases prospectively identified. Overall, any type of delay was observed in 53.8% of cases; delay related to user factors was observed in 10.2%, 34.6% of delays were related to health service accessibility and 25.7% were related to quality of medical care. The occurrence of any delay was associated with increasing severity of maternal outcome: 52% in PLTC, 68.4% in MNM and 84.1% in MD. Although this was not a population-based study and the results could not be generalized, there was a very clear and significant association between frequency of delay and severity of outcome, suggesting that timely and proper management are related to survival.

Genetic Predictors Of Long-term Response To Growth Hormone (gh) Therapy In Children With Gh Deficiency And Turner Syndrome: The Influence Of A Socs2 Polymorphism.

There is great interindividual variability in the response to GH therapy. Ascertaining genetic factors can improve the accuracy of growth response predictions. Suppressor of cytokine signaling (SOCS)-2 is an intracellular negative regulator of GH receptor (GHR) signaling. The objective of the study was to assess the influence of a SOCS2 polymorphism (rs3782415) and its interactive effect with GHR exon 3 and -202 A/C IGFBP3 (rs2854744) polymorphisms on adult height of patients treated with recombinant human GH (rhGH). Genotypes were correlated with adult height data of 65 Turner syndrome (TS) and 47 GH deficiency (GHD) patients treated with rhGH, by multiple linear regressions. Generalized multifactor dimensionality reduction was used to evaluate gene-gene interactions. Baseline clinical data were indistinguishable among patients with different genotypes. Adult height SD scores of patients with at least one SOCS2 single-nucleotide polymorphism rs3782415-C were 0.7 higher than those homozygous for the T allele (P < .001). SOCS2 (P = .003), GHR-exon 3 (P= .016) and -202 A/C IGFBP3 (P = .013) polymorphisms, together with clinical factors accounted for 58% of the variability in adult height and 82% of the total height SD score gain. Patients harboring any two negative genotypes in these three different loci (homozygosity for SOCS2 T allele; the GHR exon 3 full-length allele and/or the -202C-IGFBP3 allele) were more likely to achieve an adult height at the lower quartile (odds ratio of 13.3; 95% confidence interval of 3.2-54.2, P = .0001). The SOCS2 polymorphism (rs3782415) has an influence on the adult height of children with TS and GHD after long-term rhGH therapy. Polymorphisms located in GHR, IGFBP3, and SOCS2 loci have an influence on the growth outcomes of TS and GHD patients treated with rhGH. The use of these genetic markers could identify among rhGH-treated patients those who are genetically predisposed to have less favorable outcomes.

Compartment Syndrome After South American Rattlesnake (crotalus Durissus Terrificus) Envenomation.

In order to report the outcome of a patient who developed compartment syndrome after South American rattlesnake (Crotalus durissus terrificus) envenomation, confirmed by subfascial pressure measurement and magnetic resonance imaging (MRI). A 63-year-old male was admitted 1 h after being bitten on the right elbow by a large snake, which was not brought for identification. Physical and laboratory features upon admission revealed two fang marks, local tense swelling, paresthesia, intense local pain, hypertension, coagulopathy, and CK = 1530 U/L (RV < 170 U/L). The case was initially treated with bothropic antivenom (80 mL, intravenously), with no improvement. Evolution within 13-14 h post-bite revealed generalized myalgia, muscle weakness, palpebral ptosis, and severe rhabdomyolysis (CK = 126,160 U/L) compatible with envenoming by C. d. terrificus. The patient was then treated with crotalic antivenom (200 mL, intravenously), fluid replacement, and urine alkalinization. Twenty-four-hour post-bite MRI showed marked muscular edema in the anterior compartment of the right forearm, with a high subfascial pressure (40 mmHg) being detected 1 h later. ELISA of a blood sample obtained upon admission, before antivenom infusion, revealed a high serum concentration of C. d. terrificus venom. No fasciotomy was performed and the patient was discharged seven days later without sequelae. Snakebite by C. d. terrificus with subfascial venom injection may lead to increased intracompartmental pressure.

The Crystal-t Algorithm: A New Approach To Calculate The Sle Of Lipidic Mixtures Presenting Solid Solutions.

Lipidic mixtures present a particular phase change profile highly affected by their unique crystalline structure. However, classical solid-liquid equilibrium (SLE) thermodynamic modeling approaches, which assume the solid phase to be a pure component, sometimes fail in the correct description of the phase behavior. In addition, their inability increases with the complexity of the system. To overcome some of these problems, this study describes a new procedure to depict the SLE of fatty binary mixtures presenting solid solutions, namely the Crystal-T algorithm. Considering the non-ideality of both liquid and solid phases, this algorithm is aimed at the determination of the temperature in which the first and last crystal of the mixture melts. The evaluation is focused on experimental data measured and reported in this work for systems composed of triacylglycerols and fatty alcohols. The liquidus and solidus lines of the SLE phase diagrams were described by using excess Gibbs energy based equations, and the group contribution UNIFAC model for the calculation of the activity coefficients of both liquid and solid phases. Very low deviations of theoretical and experimental data evidenced the strength of the algorithm, contributing to the enlargement of the scope of the SLE modeling.