End-of-life practices in seven Brazilian pediatric intensive care units

Objective: To evaluate the incidence of life support limitation and medical practices in the last 48 hrs of life of children in seven Brazilian pediatric intensive care units (PICUs). Design. Cross-sectional multicenter retrospective study based on medical chart review. Setting: Seven PICUs belonging to university and tertiary hospitals located in three Brazilian regions: two in Porto Alegre (southern region), two in Sao Paulo (southeastern region), and three in Salvador (northeastern region). Patients. Medical records of all children who died in seven PICUs from January 2003 to December 2004. Deaths in the first 24 hrs of admission to the PICU and brain death were excluded. Interventions: Two pediatric intensive care residents from each PICU were trained to fill out a standard protocol (K = 0.9) to record demographic data and all medical management provided in the last 48 hrs of life (inotropes, sedatives, mechanical ventilation, full resuscitation maneuvers or not). Student`s t-test, analysis of variance, chi-square test, and relative risk were used for comparison of data. Measurements and Main Results. Five hundred and sixty-one deaths were identified; 97 records were excluded (61 because of brain death and 36 due to <24 hrs in the PICU). Thirty-six medical charts could not be found. Cardiopulmonary resuscitation was performed in 242 children (57%) with a significant difference between the southeastern and northeastern regions (p =.0003). Older age (p = .025) and longer PICU stay (p = .001) were associated with do-not-resuscitate orders. In just 52.5% of the patients with life support limitation, the decision was clearly recorded in the medical chart. No ventilatory support was provided in 14 cases. Inotropic drug infusions were maintained or increased in 66% of patients with do-not-resuscitate orders. Conclusions. The incidence of life support limitation has increased among Brazilian PICUs but with significant regional differences. Do-not-resuscitate orders are still the most common practice, with scarce initiatives for withdrawing or withholding life support measures.

HISTOLOGIC EVALUATION OF END-TO-SIDE NEURORRHAPHY. EXPERIMENTAL STUDY IN RATS

Objective: The aim of this study was to histologically compare the axonal sprouting after end-to-side neurorrhaphy with or without epineurotomy. Methods: twenty male Wistar rats were used, divided into two groups of 10 rats each. A 1.0cm segment of the tibial nerve E was dried and sutured on the opposite side, where it was sutured into the sciatic nerve D. In Group I, the suture was made directly in the epineurium and in Group II, epineurotomy was performed. After 4 weeks, histological evaluation was carried out of the transposed segment and the sciatic nerve distal to the suture. Results: the results showed a small number of remyelinated fibers, varying from 7 to 51 fibers in Group I and from 10 to 91 fibers in Group II. The Mann-Whitney U test was used, with p=0.311, showing there is no statistically significant difference between the two groups. There was no positive relation between the number of remyelinated fibers in the graft and in the suture site distal to the sciatic lesion. Conclusion: lateral-ending neurorrhaphy, with or without epineural window, does not promote efficient remyelinization. Level of Evidence: Level II, prospective comparative study.

Increased vascular O-GlcNAcylation augments reactivity to constrictor stimuli - Vasoactive Peptide Symposium

O-linked N-acetylglucosaminylation (O-GlcNAcylation) plays a role in many aspects of protein function. Whereas elevated O-GlcNAc levels contribute to diabetes-related end-organ damage, O-GlcNAcylation is also physiologically important. Because proteins that play a role in vascular tone regulation can be O-GlcNAcylated, we hypothesized that O-GlcNAcylation increases vascular reactivity to constrictor stimuli, Aortas front male Sprague-Dawley rats and C57BL/6 mice were incubated for 24 hours with vehicle or PugNAc (O-GlcNAcase inhibitor. 100 mu M). PugNAc incubation significantly increased O-GlcNAc proteins, as determined by Western blot. PugNAc also increased vascular contractions to phenylephrine and serotonin, an effect not observed in the presence of N(omega)-nitro-L-arginine methyl ester or in endothelium-denuded vessels. Acetylcholine-induced relaxation. but not that to sodium nitroprusside, was decreased by PugNAc treatment, an effect accompanied by decreased levels of phosphorylated endothelial nitric oxide synthase (eNOS)(Ser-1177) and Akt(Ser-473). Augmented O-GlcNAcylation increases vascular reactivity to constrictor stimuli, possibly due to its effects oil eNOS expression and activity, reinforcing the concept that O-GlcNAcylation modulates vascular reactivity and may play a role in pathological conditions associated with abnormal vascular function. J Am Soc Hypertens 2008:2(6): 410-417. (C) 2008 American Society of Hypertension. All rights reserved.

Front tracking with moving-least-squares surfaces

The representation of interfaces by means of the algebraic moving-least-squares (AMLS) technique is addressed. This technique, in which the interface is represented by an unconnected set of points, is interesting for evolving fluid interfaces since there is]to surface connectivity. The position of the surface points can thus be updated without concerns about the quality of any surface triangulation. We introduce a novel AMLS technique especially designed for evolving-interfaces applications that we denote RAMLS (for Robust AMLS). The main advantages with respect to previous AMLS techniques are: increased robustness, computational efficiency, and being free of user-tuned parameters. Further, we propose a new front-tracking method based on the Lagrangian advection of the unconnected point set that defines the RAMLS surface. We assume that a background Eulerian grid is defined with some grid spacing h. The advection of the point set makes the surface evolve in time. The point cloud can be regenerated at any time (in particular, we regenerate it each time step) by intersecting the gridlines with the evolved surface, which guarantees that the density of points on the surface is always well balanced. The intersection algorithm is essentially a ray-tracing algorithm, well-studied in computer graphics, in which a line (ray) is traced so as to detect all intersections with a surface. Also, the tracing of each gridline is independent and can thus be performed in parallel. Several tests are reported assessing first the accuracy of the proposed RAMLS technique, and then of the front-tracking method based on it. Comparison with previous Eulerian, Lagrangian and hybrid techniques encourage further development of the proposed method for fluid mechanics applications. (C) 2008 Elsevier Inc. All rights reserved.

Microgranitic Enclaves as Products of Self-mixing Events: a Study of Open-system Processes in the Maua Granite, Sao Paulo, Brazil, Based on in situ Isotopic and Trace Elements in Plagioclase

Felsic microgranular enclaves with structures indicating that they interacted in a plastic state with their chemically similar host granite are abundant in the Maua Pluton, SE Brazil. Larger plagioclase xenocrysts are in textural disequilibrium with the enclave groundmass and show complex zoning patterns with partially resorbed An-rich cores (locally with patchy textures) surrounded by more sodic rims. In situ laser ablation-(multi-collector) inductively coupled plasma mass spectrometry trace element and Sr isotopic analyses performed on the plagioclase xenocrysts indicate open-system crystallization; however, no evidence of derivation from more primitive basic melts is observed. The An-rich cores have more radiogenic initial Sr isotopic ratios that decrease towards the outermost part of the rims, which are in isotopic equilibrium with the matrix plagioclase. These profiles may have been produced by either (1) diffusional re-equilibration after rim crystallization from the enclave-forming magma, as indicated by relatively short calculated residence times, or (2) episodic contamination with a decrease of the contaminant ratio proportional to the extent to which the country rocks were isolated by the crystallization front. Profiles of trace elements with high diffusion coefficients would require unrealistically long residence times, and can be modeled in terms of fractional crystallization. A combination of trace element and Sr isotope data suggests that the felsic microgranular enclaves from the Maua Pluton are the products of interaction between end-member magmas that had similar compositions, thus recording `self-mixing` events.

Computational aspects of harmonic wavelet Galerkin methods and an application to a precipitation front propagation model

This article is dedicated to harmonic wavelet Galerkin methods for the solution of partial differential equations. Several variants of the method are proposed and analyzed, using the Burgers equation as a test model. The computational complexity can be reduced when the localization properties of the wavelets and restricted interactions between different scales are exploited. The resulting variants of the method have computational complexities ranging from O(N(3)) to O(N) (N being the space dimension) per time step. A pseudo-spectral wavelet scheme is also described and compared to the methods based on connection coefficients. The harmonic wavelet Galerkin scheme is applied to a nonlinear model for the propagation of precipitation fronts, with the front locations being exposed in the sizes of the localized wavelet coefficients. (C) 2011 Elsevier Ltd. All rights reserved.

A Robust, Fully Adaptive Hybrid Level-Set/Front-Tracking Method for Two-Phase Flows with an Accurate Surface Tension Computation

We present a variable time step, fully adaptive in space, hybrid method for the accurate simulation of incompressible two-phase flows in the presence of surface tension in two dimensions. The method is based on the hybrid level set/front-tracking approach proposed in [H. D. Ceniceros and A. M. Roma, J. Comput. Phys., 205, 391400, 2005]. Geometric, interfacial quantities are computed from front-tracking via the immersed-boundary setting while the signed distance (level set) function, which is evaluated fast and to machine precision, is used as a fluid indicator. The surface tension force is obtained by employing the mixed Eulerian/Lagrangian representation introduced in [S. Shin, S. I. Abdel-Khalik, V. Daru and D. Juric, J. Comput. Phys., 203, 493-516, 2005] whose success for greatly reducing parasitic currents has been demonstrated. The use of our accurate fluid indicator together with effective Lagrangian marker control enhance this parasitic current reduction by several orders of magnitude. To resolve accurately and efficiently sharp gradients and salient flow features we employ dynamic, adaptive mesh refinements. This spatial adaption is used in concert with a dynamic control of the distribution of the Lagrangian nodes along the fluid interface and a variable time step, linearly implicit time integration scheme. We present numerical examples designed to test the capabilities and performance of the proposed approach as well as three applications: the long-time evolution of a fluid interface undergoing Rayleigh-Taylor instability, an example of bubble ascending dynamics, and a drop impacting on a free interface whose dynamics we compare with both existing numerical and experimental data.

Intrachain Energy Migration to Weak Charge-Transfer State in Polyfluorene End-Capped with Naphthalimide Derivative

Polyfluorene end-capped with N-(2-benzothiazole)-1 8-naphthalimide (PF-BNI) is a highly fluorescent material with fluorescence emission modulated by solvent polarity Its low energy excited state is assigned as a mixed configuration state between the singlet S(1) of the fluorene backbone (F) with the charge transfer (CI) of the end group BNI The triexponential fluorescence decays of PF-BNI were associated with fast energy migration to form an intrachain charge-transfer (ICCT) state polyfluorene backbone decay and ICCT deactivation Time-resolved fluorescence anisotropy exhibited biexponential relaxation with a fast component of 12-16 ps in addition to a slow one in the range 0 8-1 4 ns depending on the solvent showing that depolarization occurs from two different processes energy migration to form the ICCT state and slow rotational diffusion motion of end segments at a longer time Results from femtosecond transient absorption measurements agreed with anisotropy decay and showed a decay component of about 16 ps at 605 nm in PF BNI ascribed to the conversion of S(1) to the ICCT excited state From the ratio of asymptotic and initial amplitudes of the transient absorption measurement the efficiency of intrachain ICCT formation is estimated in 0 5 which means that on average, half of the excited state formed in a BNI-(F)(n)-BNI chain with n = 32 is converted to its low energy intrachain charge-transfer (ICCT) state

Implementation and role of device management Solutions to the end users

This research is based on consumer complaints with respect to recently purchased consumer electronics. This research document will investigate the instances of development and device management as a tool used to aid consumer and manage consumer’s mobile products in order to resolve issues in or before the consumers is aware one exists. The problem at the present time is that mobile devices are becoming very advanced pieces of technology, and not all manufacturers and network providers have kept up the support element of End users. As such, the subject of the research is to investigate how device management could possibly be used as a method to promote research and development of mobile devices, and provide a better experience for the consumer. The wireless world is becoming increasingly complex as revenue opportunities are driven by new and innovative data services. We can no longer expect the customer to have the knowledge or ability to configure their own device. Device Management platforms can address the challenges of device configuration and support through new enabling technologies. Leveraging these technologies will allow a network operator to reduce the cost of subscriber ownership, drive increased ARPU (Average Revenue per User) by removing barriers to adoption, reduce churn by improving the customer experience and increase customer loyalty. DM technologies provide a flexible and powerful management method but are managing the same device features that have historically been configured manually through call centers or by the end user making changes directly on the device. For this reason DM technologies must be treated as part of a wider support solution. The traditional requirement for discovery, fault finding, troubleshooting and diagnosis are still as relevant with DM as they are in the current human support environment yet the current generation of solutions do little to address this problem. In the deployment of an effective Device Management solution the network operator must consider the integration of the DM platform, interfacing with many areas of the business, supported by knowledge of the relationship between devices, applications, solutions and services maintained on an ongoing basis. Complementing the DM solution with published device information, setup guides, training material and web based tools will ensure the quality of the customer experience, ensuring that problems are completely resolved, driving data usage by focusing customer education on the use of the wireless service In this way device management becomes a tool used both internally within the network or device vendor and by the customer themselves, with each user empowered to effectively manage the device without any prior knowledge or experience, confident that changes they apply will be relevant, accurate, stable and compatible. The value offered by an effective DM solution with an expert knowledge service will become a significant differentiator for the network operator in an ever competitive wireless market. This research document is intended to highlight some of the issues the industry faces as device management technologies become more prevalent, and offers some potential solutions to simplify the increasingly complex task of managing devices on the network, where device management can be used as a tool to aid customer relations and manage customer’s mobile products in order to resolve issues before the user is aware one exists. The research is broken down into the following, Customer Relationship Management, Device management, the role of knowledge with the DM, Companies that have successfully implemented device management, and the future of device management and CRM. And it also consists of questionnaires aimed at technical support agents and mobile device users. Interview was carried out with CRM managers within support centre to further the evidence gathered. To conclude, the document is to consider the advantages and disadvantages of device management and attempt to determine the influence it will have over customer support centre, and what methods could be used to implement it.

Brand Awareness among Customers : A case study of ICA-Kvantum

This research paper has been prepared by Bachelor students from Dalarna University in Borlänge. The project is centered on a case study of ICA – Kvantum and its brand awareness among customers. The purpose of this study is to find out that which measures can help ICA-Kvantum to create brand awareness among its current and potential customers by looking in to the importance of information of its offerings and use of effective communication tools to convey this information. Further, to recommend them what they need to do, to increase brand awareness among their customers with the help of managerial implications. The research question was formulated as what actions could be seen effective for ICA-Kvantum to maintain or improve brand awareness among its current and potential customers.The project was created with the help of theoretical concepts of brand awareness, brand loyalty, perceived quality, consumer decision model, integrated marketing communication approach and strategic planning process. These theories were applied in this thesis in order to find out the most effective communication measures to maintain or improve brand awareness among current and potential customers of ICA-Kvantum.The primary and secondary data was collected. Primary data was gathered through the survey among ICA-Kvantum customers in the front of the store in Borlänge. The personal interview with manager was conducted in the office of ICA-Kvantum store located in Borlänge. Secondary data was gathered from textbooks, academic journals, theses and websites.The empirical findings have been presented in detail and then analyzed with the help of theoretical concepts. The analysis and further results from survey and interview focused on importance of information, marketing communication tools, brand awareness and loyalty, perceived quality and implementation of strategic planning process. Moreover, the main weaknesses and strengths of ICA-Kvantun have been evaluated. The conclusion including short summary of analysis and its results have been provided at the end. Each weakness of issues related to brand awareness i.e. importance of information, effectiveness of marketing communication tools and strengths and weaknesses of ICA-Kvantum discussed in the paper, has been pointed out along with solutions and managerial implications.

Det är enklare i teorin… Om skolutveckling i praktiken : En fallstudie av ett skolutvecklingsprojekt i en gymnasieskola

This dissertation is a case study dealing with a school development project that took place in an upper secondary school as a result of a merger of two schools with different cultures. The project used a method called “Frirumsmodellen” and was planned to be conducted in three steps. The first was to carry out a cultural analysis in order to map the preconditions to start a school development project. The second was to carry out concrete actions and finally study eventual effects from such activities by doing a second cultural analysis. My role was to be a supervisor in the school development work, but at the same time study how this work was conducted and its impact in the ordinary school day. The dissertation takes its departure in the fact that schools are political governed. The mission of schools is never neutral; it is always an expression of behind laying social forces, ideologies and ideals of the contemporary society. Of this reason, there is a close connection between the macro political level and the micro political level. Another point of departure is the transition from a modern to a post modern society that gives the character to the changes that take place in schools. Steering of schools has partly been treated as a technical implementation problem. Schools contain on going conflicts between different interest groups that, more or less regularly, end up in educational reforms. These reforms generate school development activities in the single school. Undoubtedly, this makes school development to a complex process. At a rather late stage of the study I decided not to fulfil my task to follow the original plan. I instead let the school development project as a model to be in focus. The over all purpose was formulated: How is it possible to understand what happened in the school development project in the Falkgymnasiet and why was it not possible to carry it out as it was said in the project plan? To interpret what took place during the project I did create an interpretation frame of implementation and complexity theory that also made it possible to critically scrutinise the “Frirumsmodellen”. Already in an early stage of the process it was obvious that the “Frirumsmodellen” did not supply any tools to use and it became disconnected from the project. The project in it selves was marginalised and made invisible. The headmaster used the situation to change things she thought were important to develop. As a result, things happened, but most of the involved people did not at first hand connect this to the project. It is, of course, difficult in detail to say what caused what. The complexity theory successively made the hidden patterns revealed, hidden unofficial potentates visible, as well as unpredictable conditions that generated reactions from the personnel in front of a development work. Together this was rather efficient obstacles for not changing this school. I also discuss school development and implementation problems on a general level, for example, the possibility to transform a top-down initiated project to be bottom-up driven and using project as a tool for school development work. It was obvious that headmasters and teachers must be prepared to handle the ideological dimensions of problems schools have to face. Consequently, development work is about making problems visible and to handle these in the intersection point between the intentions of educational policies, pedagogical researchers, school administrators, headmasters, teachers and pupils. The ideological dimension also contains an existential issue. Do I as a teacher share the intentions for the development work? If not, how must I act?

Can’t Afford the Manolos? Buy the Book!: Chick Lit & Contemporary Consumerism

At the airport, across from the magazines at Wal-Mart, and probably somewhere near the front of local bookstores — chick lit is everywhere. One would probably recognize it from a distance as a sea of shiny pink1, the small glossy paperbacks cheerfully beckoning from their carefully constructed display. Chick lit has exploded into the western2 market over the last decade, captivating millions of readers with their tales of young, urban professional women navigating the worlds of careers, relationships, and of course, shopping. By the end of the novel, each of these components is generally resolved in somewhat formulaic fashion

Stranger in a Strange Land: The struggle for cultural and personal identity in Haruki Murakami's Hard-Boiled Wonderland and the End of the World

In order to explicate Murakami's version of the official culture, I have analyzed the novel with the works of several different theorists. Primarily, I drew my own understanding of the official culture from Raymond Williams's examination of culture in Marxism and Literature. His terminology became helpful in writing about the operation of the System and the Town, though it did not define that operation precisely. Williams's work also introduced me to the theory behind the official culture's manipulation and exclusion of historical aspects in order to create their "official" version of history, from which the official culture draws its identity. For further analysis of the treatment of history, I turned to Friedrich Nietzsche's On the Advantage and Disadvantage of History for Life. Though it examines the official culture's manipulation of history in a much more in-depth manner, it seems to have influenced Murakami's treatment of individual memories and cultural histories. For instance, the herd ofunicoms in the End of the World resembles Nietzsche's description of the ''unhistorical herd," or has the potential to resemble it. With these theories I was able to access the mechanisms of cultural control that Murakami depicts in the form of the System and the Town, and from there I was able to develop a model for how the narrator struggles to subvert that control. Both sides of that struggle are depicted and re-imagined many times throughout Hard-Boiled Wonderland and the End of the World.