Estudo da Acessibilidade Organizacional aos Serviços de Saúde Bucal de um Município de Pequeno Porte do Nordeste Brasileiro

Objective: This study aimed to evaluate the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect which is characterized by variables like delay in getting consultation, waiting lines, difficulty scheduling appointments, lack of material, among others. Material and Methods: For such purpose, questionnaires were addressed to 194 users’ houses based on census tract. Results: It has been found that 12.9% of the population has never gone to the dentist’s office, and that the service demand has not been affected by users’ individual and socioeconomic characteristics, except for gender. Data have revealed that 36.1% of users went to the dentist’s in less than a year. In addition, the youngest users are among those who seek the dentist’s office more frequently (p<0.05). 63.3% of the interviewees have reported they find some kind of difficulty when seek for dental care, and 43.2% of users have waited three weeks or more for assistance. It is also noteworthy that 7.4% of the interviewees have been finding difficulties in getting access to urgency care, and that long wait for the consultation is the most frequently cited matter. Conclusion: It could be verified that accessibility to oral health services in the municipality of Santa Cruz (RN) has been hampered by factors related to public policies organization, especially with regards to the work process.

Estudo da Acessibilidade Organizacional aos Serviços de Saúde Bucal de um Município de Pequeno Porte do Nordeste Brasileiro

Objective: This study aimed to evaluate the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect which is characterized by variables like delay in getting consultation, waiting lines, difficulty scheduling appointments, lack of material, among others. Material and Methods: For such purpose, questionnaires were addressed to 194 users’ houses based on census tract. Results: It has been found that 12.9% of the population has never gone to the dentist’s office, and that the service demand has not been affected by users’ individual and socioeconomic characteristics, except for gender. Data have revealed that 36.1% of users went to the dentist’s in less than a year. In addition, the youngest users are among those who seek the dentist’s office more frequently (p<0.05). 63.3% of the interviewees have reported they find some kind of difficulty when seek for dental care, and 43.2% of users have waited three weeks or more for assistance. It is also noteworthy that 7.4% of the interviewees have been finding difficulties in getting access to urgency care, and that long wait for the consultation is the most frequently cited matter. Conclusion: It could be verified that accessibility to oral health services in the municipality of Santa Cruz (RN) has been hampered by factors related to public policies organization, especially with regards to the work process.

Monitoring of down-hole parameters for early kick detection

The sudden hydrocarbon influx from the formation into the wellbore poses a serious risk to the safety of the well. This sudden influx is termed a kick, which, if not controlled, may lead to a blowout. Therefore, early detection of the kick is crucial to minimize the possibility of a blowout occurrence. There is a high probability of delay in kick detection, apart from other issues when using a kick detection system that is exclusively based on surface monitoring. Down-hole monitoring techniques have a potential to detect a kick at its early stage. Down-hole monitoring could be particularly beneficial when the influx occurs as a result of a lost circulation scenario. In a lost circulation scenario, when the down-hole pressure becomes lower than the formation pore pressure, the formation fluid may starts to enter the wellbore. The lost volume of the drilling fluid is compensated by the formation fluid flowing into the well bore, making it difficult to identify the kick based on pit (mud tank) volume observations at the surface. This experimental study investigates the occurrence of a kick based on relative changes in the mass flow rate, pressure, density, and the conductivity of the fluid in the down-hole. Moreover, the parameters that are most sensitive to formation fluid are identified and a methodology to detect a kick without false alarms is reported. Pressure transmitter, the Coriolis flow and density meter, and the conductivity sensor are employed to observe the deteriorating well conditions in the down-hole. These observations are used to assess the occurrence of a kick and associated blowout risk. Monitoring of multiple down-hole parameters has a potential to improve the accuracy of interpretation related to kick occurrence, reduces the number of false alarms, and provides a broad picture of down-hole conditions. The down-hole monitoring techniques have a potential to reduce the kick detection period. A down-hole assembly of the laboratory scale drilling rig model and kick injection setup were designed, measuring instruments were acquired, a frame was fabricated, and the experimental set-up was assembled and tested. This set-up has the necessary features to evaluate kick events while implementing down-hole monitoring techniques. Various kick events are simulated on the drilling rig model. During the first set of experiments compressed air (which represents the formation fluid) is injected with constant pressure margin. In the second set of experiments the compressed air is injected with another pressure margin. The experiments are repeated with another pump (flow) rate as well. This thesis consists of three main parts. The first part gives the general introduction, motivation, outline of the thesis, and a brief description of influx: its causes, various leading and lagging indicators, and description of the several kick detection systems that are in practice in the industry. The second part describes the design and construction of the laboratory scale down-hole assembly of the drilling rig and kick injection setup, which is used to implement the proposed methodology for early kick detection. The third part discusses the experimental work, describes the methodology for early kick detection, and presents experimental results that show how different influx events affect the mass flow rate, pressure, conductivity, and density of the fluid in the down-hole, and the discussion of the results. The last chapter contains summary of the study and future research.

Norms of inner derivations for multiplier algebras of C ∗ -algebras and group C ∗ -algebras, II

Peer reviewed

On string topology of classifying spaces

Peer reviewed

Finite Group Actions on Kervaire Manifolds

Date of Acceptance: 09/06/2015

Norms of inner derivations for multiplier algebras of C ∗ -algebras and group C ∗ -algebras, II

Peer reviewed

On string topology of classifying spaces

Peer reviewed

Finite Group Actions on Kervaire Manifolds

Date of Acceptance: 09/06/2015

On string topology of classifying spaces

Peer reviewed

Finite Group Actions on Kervaire Manifolds

Date of Acceptance: 09/06/2015

Seawater carbonate chemistry and biological processes of Mytilus edulis during experiments, 2011

Ocean acidification (OA) resulting from anthropogenic emissions of carbon dioxide (CO2) has already lowered and is predicted to further lower surface ocean pH. There is a particular need to study effects of OA on organisms living in cold-water environments due to the higher solubility of CO2 at lower temperatures. Mussel larvae (Mytilus edulis) and shrimp larvae (Pandalus borealis) were kept under an ocean acidification scenario predicted for the year 2100 (pH 7.6) and compared against identical batches of organisms held under the current oceanic pH of 8.1, which acted as a control. The temperature was held at a constant 10°C in the mussel experiment and at 5°C in the shrimp experiment. There was no marked effect on fertilization success, development time, or abnormality to the D-shell stage, or on feeding of mussel larvae in the low-pH (pH 7.6) treatment. Mytilus edulis larvae were still able to develop a shell in seawater undersaturated with respect to aragonite (a mineral form of CaCO3), but the size of low-pH larvae was significantly smaller than in the control. After 2 mo of exposure the mussels were 28% smaller in the pH 7.6 treatment than in the control. The experiment with Pandalus borealis larvae ran from 1 through 35 days post hatch. Survival of shrimp larvae was not reduced after 5 wk of exposure to pH 7.6, but a significant delay in zoeal progression (development time) was observed.

THE EFFECT OF PREECLAMPSIA ON RENAL FUNCTION: CROSS-SECTIONAL STUDIES OF POSTPARTUM PREECLAMPTICS AND WOMEN WHO WERE DESTINED TO DEVELOP PREECLAMPSIA

Preeclampsia (PE) is a pregnancy complication that is new-onset of hypertension and proteinuria after 20 weeks of gestation. However, subclinical renal dysfunction may be apparent earlier in gestation prior to the clinical presentation of PE. Although the maternal syndrome of PE resolves early postpartum, women with a history of PE are at higher risk of renal dysfunction later in life. Mineral metabolism, such as phosphate balance is heavily dependent on renal function, yet, phosphate handling in women with a history of PE is largely unknown. To investigate whether women with a history of PE would exhibit changes in phosphate metabolism compared to healthy parous women, phosphate loading test was used. Women with or without a history of PE, who were 6 months to 5 years postpartum, were recruited for this study. Blood and urine samples were collected before and after the oral dosing of 500mg phosphate solution. Biochemical markers of phosphate metabolism and renal function were evaluated. In order to assess the difference in renal function alteration between first trimester women who were or were not destined to develop PE, plasma cystatin C concentration was analysed. After phosphate loading, women with a history of PE had significantly elevated serum phosphate at both 1- and 2-hour, while controls had higher urine phosphate:urine creatinine excretion ratio at 1-hour than women with a history of PE. Women with a history of PE had no changes in intact parathyroid hormone (iPTH) concentration throughout the study period, whereas controls had elevated iPTH at 1-hour from baseline. In terms of renal function in the first trimester, there was no difference in plasma cystatin C concentration between women who were or were not destined to develop PE. The elevation of serum phosphate in women with a history of PE could be due to the delay in phosphate excretion. Prolong elevation of serum phosphate can have serious consequences later in life. Thus, oral phosphate challenge may serve as a useful method of early screening for altered phosphate metabolism and renal function.

THE EFFECT OF PREECLAMPSIA ON RENAL FUNCTION: CROSS-SECTIONAL STUDIES OF POSTPARTUM PREECLAMPTICS AND WOMEN WHO WERE DESTINED TO DEVELOP PREECLAMPSIA

Preeclampsia (PE) is a pregnancy complication that is new-onset of hypertension and proteinuria after 20 weeks of gestation. However, subclinical renal dysfunction may be apparent earlier in gestation prior to the clinical presentation of PE. Although the maternal syndrome of PE resolves early postpartum, women with a history of PE are at higher risk of renal dysfunction later in life. Mineral metabolism, such as phosphate balance is heavily dependent on renal function, yet, phosphate handling in women with a history of PE is largely unknown. To investigate whether women with a history of PE would exhibit changes in phosphate metabolism compared to healthy parous women, phosphate loading test was used. Women with or without a history of PE, who were 6 months to 5 years postpartum, were recruited for this study. Blood and urine samples were collected before and after the oral dosing of 500mg phosphate solution. Biochemical markers of phosphate metabolism and renal function were evaluated. In order to assess the difference in renal function alteration between first trimester women who were or were not destined to develop PE, plasma cystatin C concentration was analysed. After phosphate loading, women with a history of PE had significantly elevated serum phosphate at both 1- and 2-hour, while controls had higher urine phosphate:urine creatinine excretion ratio at 1-hour than women with a history of PE. Women with a history of PE had no changes in intact parathyroid hormone (iPTH) concentration throughout the study period, whereas controls had elevated iPTH at 1-hour from baseline. In terms of renal function in the first trimester, there was no difference in plasma cystatin C concentration between women who were or were not destined to develop PE. The elevation of serum phosphate in women with a history of PE could be due to the delay in phosphate excretion. Prolong elevation of serum phosphate can have serious consequences later in life. Thus, oral phosphate challenge may serve as a useful method of early screening for altered phosphate metabolism and renal function.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, Jokinen M, Kemp B, Kurinczuk JJ, Lewis G, Lindquist A, Locock L, Nair M, Patel N, Quigley M, Ridge D, Rivero-Arias O, Sellers S, Shah A on behalf of the UKNeS coapplicant group. Background Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision. Objectives To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts. Methods Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group. Setting Maternity units in all four countries of the UK. Participants Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity. Main outcome measures The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches. Results Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services. Limitations This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded. Conclusions Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.