Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal immunisation of infants in Brazil

Background Cost-effectiveness studies have been increasingly part of decision processes for incorporating new vaccines into the Brazilian National Immunisation Program. This study aimed to evaluate the cost-effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) in the universal childhood immunisation programme in Brazil. Methods A decision-tree analytical model based on the ProVac Initiative pneumococcus model was used, following 25 successive cohorts from birth until 5 years of age. Two strategies were compared: (1) status quo and (2) universal childhood immunisation programme with PCV10. Epidemiological and cost estimates for pneumococcal disease were based on National Health Information Systems and literature. A 'top-down' costing approach was employed. Costs are reported in 2004 Brazilian reals. Costs and benefits were discounted at 3%. Results 25 years after implementing the PCV10 immunisation programme, 10 226 deaths, 360 657 disability-adjusted life years (DALYs), 433 808 hospitalisations and 5 117 109 outpatient visits would be avoided. The cost of the immunisation programme would be R$10 674 478 765, and the expected savings on direct medical costs and family costs would be R$1 036 958 639 and R$209 919 404, respectively. This resulted in an incremental cost-effectiveness ratio of R$778 145/death avoided and R$22 066/DALY avoided from the society perspective. Conclusion The PCV10 universal infant immunisation programme is a cost-effective intervention (1-3 GDP per capita/DALY avoided). Owing to the uncertain burden of disease data, as well as unclear long-term vaccine effects, surveillance systems to monitor the long-term effects of this programme will be essential.

Sleep disorders in climacteric women

Introduction: This paper examines the various factors that contribute to the occurrence of sleep alterations during peri and post climacteric and thus produce significant imperil to women's quality of life. Among the probable causes of insomnia or sleep disorders associated to climacteric stand out the occurrence of vasomotor symptoms, depressive state and respiratory distress during sleep, such as sleep apnea, along with chronic pain, although psychosocial factors related to the climacteric bear major influence on such clinical status. Method: The bibliographic analysis was carried out using several electronic data base namely: Cochrane, Medline, Embase, Bni Plus, Biological Abstracts, Psycinfo, Web Of Science, Sigle, Dissertation Abstracts and ZETOC published in English, Spanish and Poruguese. The key terms used were: sleep, REM sleep, slow wave sleep polysomnography; electroencephalogram; sleep disturbances; disturbances of sleep onset and maintenance; excessive somnolence disturbances; climacteric; menopause; depression; neurobiology; biologic models; circadian rhythm; mental health and epidemiology. Case studies and letters to the editor were excluded. The summaries of the identified studies found in the data base were analyzed and assessed, and the data analyzed separately according to the subjective or objective criteria for data collection. Results: The climacteric transition constitutes a period of major risk for the development of depressive, vasomotor and insomnia symptoms although not caused solely by hypoestrogenism. The diagnostic methods used in the study of sleep disorders range from subjective assessment by means of response to specific questionnaires to the objective analysis of actigraphic or polissonographic daytime and nocturnal reports. Polissonographic studies of the whole night, performed at the laboratory, are the golden method of choice for diagnostic of sleep disorders. Studies point to the high prevalence of sleep disorders in the climacteric, especially insomnia, apnea and periodic movement of legs and also to the fact that this phase of life presents decrease in the quality of sleep. Women in peri and post climacteric show higher sleep latency and difficulty in its maintenance and refer being less satisfied with its quality even when compared to those who are not climacteric. Exception made to the vasomotor symptomatology, the other climacteric complaints such as mood disturbances, libido alterations, cognitive deficit, articular pain and sleep disorders are markedly associated to psychosocial factors, lifestyle and especially to women's perception of what the climacteric means to their lives. Conclusion: The analysis of the available studies revealed a proneness to deterioration of quality of life of climacteric women markedly in the sleep disturbances, depressed mood and anxiety domains and should not to be basically attributed to the climacteric. It is necessary that the professionals consider the need of assessment of such pathologies as complex phenomena and the literature lacks studies contemplating such dimensions.

Sistema de gestão para linguagem documentária metadados e rede colaborativa no vocabulário controlado do SIBI/USP

Sistemas de gestão desenvolvidos para a web, a partir de metadados, permitem manutenção eficiente de grandes quantidades de informação. Um vocabulário controlado como o utilizado pelo Sistema Integrado de Bibliotecas da USP (SIBi/USP) necessita de atualização contínua realizada através de uma rede colaborativa com a participação de bibliotecários indexadores de todas as áreas do conhecimento. Este trabalho apresenta os resultados obtidos com o sistema de gestão desenvolvido pelo Grupo de Gerenciamento para a manutenção do Vocabulário Controlado do SIBi/USP. O fluxo deste sistema consiste em filtros de validação realizados pelos componentes do Grupo de Gerenciamento do Vocabulário. A metodologia de gestão do Vocabulário possui além deste sistema, uma política de governança. Os resultados obtidos nos seis anos desde a ativação do sistema de gestão pela Base de Sugestões consistiram em: 1192 inclusões de descritores, 240 alterações, 61 exclusões, totalizando 1493 operações. A gestão e o controle de qualidade do Vocabulário permitiram o aprimoramento do tratamento e da recuperação da informação no Banco de Dados Bibliográficos da USP – DEDALUS.

Desarrollo de interfaces de usuario para una herramienta de telecontrol y automatización industrial

[ES] Este proyecto de fin de carrera aborda la actualización y refactorización de la aplicación Hecaton. Esta aplicación permite la monitorización y actuación en instalaciones industriales de manera remota a través de un interfaz web. Para ello hace uso de sensores y actuadores que, conectados a través de un equipo de adquisición de datos a un sistema informático servidor, permiten obtener, manipular y almacenar los datos y eventos recibidos. Hecaton ha sido desarrollado enteramente utilizando software libre. Además, el sistema permite ser personalizado, lo que posibilita su uso en todo tipo de escenarios, siendo el usuario quién define las reglas de funcionamiento. Este trabajo se trata del cuarto ciclo de desarrollo, pues la aplicación ha sido crea y ampliada en otros tres proyectos. En este último desarrollo se han actualizado las tecnologías y herramientas que forman parte de la aplicación. Se ha puesto especial énfasis en el rediseño de la interfaz web, adoptando el uso de las últimas tecnologías web que permiten un funcionamiento dinámico de la misma. Por otro lado se han corregido algunos errores de diseño e introducido el uso de nuevas herramientas para la gestión del proyecto software. Se trata por lo tanto de un ejercicio de refactorización software donde se ha puesto especial atención en conseguir un proyecto actualizado y que utilice metodologías de desarrollo actuales y que posibilite que sea actualizado en un futuro.

Diseño e implementación de un gestor de menús como aplicación web

[ES] Este Trabajo de Fin de Grado ha tenido como objetivo el desarrollo de un gestor de menús de restaurantes como aplicación web para una empresa que ofrece hostings de menús y publicidad mediante la publicación de dichos menús en pantallas y portales web. Las empresas asociadas (bares y restaurantes) podrán elaborar menús compuestos de dos platos (primero y segundo), postre y bebidas para ser ‘enviados’ al servicio de publicación. La aplicación proporciona un sistema de gestión de dichos menús facilitando la reutilización de platos entre menús, la personalización de la imagen representativa de cada plato, así como diversas operaciones de copia, visualización y modificación de los menús y de los platos. Los usuarios registrados tendrán la posibilidad de recuperar su contraseña de forma automática en caso de que la misma sea olvidada. La información relacionada con los platos, menús y usuarios registrados será almacenada automáticamente sobre una base de datos diseñada al efecto. Por otro lado, la aplicación web dispone de una página accesible únicamente para el administrador para la gestión de los usuarios, por ejemplo, editar, alta, baja, habilitar y deshabilitar cuentas de usuarios. Por último, las tecnologías y herramientas utilizadas en la elaboración de este trabajo incluyen Php, Mysql, jQuery, CSS, HTML y sobre todo el framework Twitter Bootstrap que ha sido de gran ayuda en el desarrollo del proyecto.

Query Player : a component for Triskel architecture

[ES] Uno de los cinco componentes de la arquitectura triskel,  una base de datos NoSQL que trata de dar solución al problema de Big data de la web semántica, el  gran número de identificadores de recursos que se necesitarían debido al creciente número de sitios web, concretamente el motor de gestión de ejecución de patrones basados en tripletas y en la tecnología RDF. Se encarga de recoger la petición de consulta por parte del intérprete, analizar los patrones que intervienen en la consulta en busca de dependencias explotables entre ellos, y así poder realizar la consulta con mayor rapidez además de ir resolviendo los diferentes patrones contra el almacenamiento, un TripleStore, y devolver el resultado de la petición en una tabla.

Metodi numerici per lo studio di centri di lavoro ad alta velocità

A Machining Centre is nowadays a complex mechanical, electronic, electrical system that needs integrated design capabilities which very often require a high time-consuming effort. Numerical techniques for designing and dimensioning the machine structure and components usually requires different knowledge according to the system that have to be designed. This Ph. D Thesis is related about the efforts of the Authors to develop a system that allows to perform the complete project of a new machine optimized in its dynamic behaviour. An integration of the different systems developed, each of which respond to specific necessities of designer, is here presented. In particular a dynamic analysis system, based on a lumped mass approach, that rapidly allows to setup the drives of the machine and an Integrated Dynamic Simulation System, based on a FEM approach, that permit a dynamic optimization, are shown. A multilevel Data Base, and an operator interface module provide to complete the designing platform. The proposed approach represents a significant step toward the virtual machining for the prediction of the quality of the worked surface.

Biogeographische Beziehungen zwischen den Alpen, dem Kaukasus und den asiatischen Hochgebirgen

Hintergrund: Biogeographische Verbindungen der Alpen nach Asien wurden schon im 19. Jahrhundert durch floristische Vergleiche entdeckt. Ziele: In den vorliegenden drei Artikeln wird untersucht, ob diese Verbindung entlang einer nördlichen, arktisch-borealen Route oder entlang einer südlichen Route über dazwischen liegende Gebirge wie den Kaukasus bestand. Methoden: Molekulare Phylogenien von Epimedium (Berberidaceae) und der Tribus der Hyoscyameae (Solanaceae), deren Vertreter disjunkt in den Alpen, dem Kaukasus und in asiatischen Gebirgen vorkommen, wurden mit nukleären und plastidären Markern erstellt und bio¬geographisch ausgewertet. Zur Datierung der Diversifizierungsereignisse und Arealbil¬dung diente eine molekulare Uhr. Ein aktueller floristischer Vergleich von Gattungen, die in den Alpen, den asiatischen Gebirgen und in Gebieten entlang der potentiellen Routen vor¬kom¬men, wurde unternommen und ausgewertet. Daran anschließend wurde nach molekular-phylogenetischer Literatur für interessante Gruppen aus diesem Ver¬gleich recherchiert, um diese biogeogra¬phisch bezüglich der Fragestellung zu interpretieren. Ergebnisse: Von 429 Gattungen, die in den Alpen und im Himalaya vorkommen, wachsen 218 entlang der nördlichen und der südlichen Route. 203 kommen nur entlang der süd¬lichen und drei nur entlang der nördlichen Route vor. Fünf kommen nur in den Alpen und im Himalaya vor. Epimedium, Scopolia/Physochlaina aus den Hyoscyameae und Primula sect. Auricula sind Beispiele für eine nördliche biogeographische Verbindung zwischen den Alpen und Asien. Diese bestand zumindest in den ersten beiden Fällen wahrscheinlich aus einem durchgängigen Laubwaldgürtel, der durch das abkühlende und trockener werdende Klima im Pliozän und Pleistozän fragmentiert wurde und heute nicht mehr besteht. Es handelt sich also um ein Vikarianzmuster und weniger um eine Migrationsroute. Die größere Diver¬sität dieser Guppen, die in Asien beobachtet werden kann ist sekundär entstanden. Atropa aus den Hyoscyameae, Brachypodium, die Subtribus Loliinae aus den Poaceae, Bupleurum und Doronicum sind Beispiele für eine südliche Verbindung. Hier liegen die Diversitätszentren im Mediterraneum und die Vorkommen im Osten sind abgeleitet. Schlussfolgerungen: Die Datengrundlage aus der Literaturrecherche ist nicht sehr breit und die meisten Phylogenien waren für die Fragestellung nicht aussagekräftig. Die histori¬schen Erkenntnisse und die Ideen über den Zusammenhang der Alpenflora mit der asiatischer Gebirge werden grundsätzlich bestärkt. Die Flora der Alpen enthält ein Element das über eine nördliche Verbindung noch lange mit asiatischen Gebirgen in Kontakt stand und ein südliches Element, das aus dem Mittelmeer¬raum bzw. aus SW Asien stammt. Die Beispiele für eine nördliche Verbindung sprechen allerdings nicht für eine Migration von Asien nach Europa sondern zeigen ein Vikarianzmuster auf.

Confronto fra cerchiaggio cervicale elettivo, eco-indicato e d’emergenza dal 2001 al 2013

Obiettivi: L’obiettivo dello studio è stato quello di valutare l’utilizzo del cerchiaggio cervicale, in relazione alle diverse indicazioni per cui è stato eseguito, presso la Clinica Ostetrica e Ginecologica del Policlinico Universitario Sant’Orsola-Malpighi di Bologna, tra Gennaio 2001 e Dicembre 2013. Outcome secondario e’ stato quello di paragonare i risultati ottenuti con le più recenti evidenze scientifiche per valutare come esse abbiano influenzato l’utilizzo del cerchiaggio nel nostro centro. Materiali e metodi: valutazione osservazionale di tutte le pazienti sottoposte a cerchiaggio cervicale presso il nostro centro. La popolazione di studio e’ stata suddivisa in 5 gruppi in relazione all’indicazione per cui il cerchiaggio e’ stato eseguito: cerchiaggio elettivo (I), eco indicato (II), d’emergenza (III), in gravidanze gemellari (IV) e in gravidanze trigemine (V). Di tutte le pazienti e’ stato valutato l’outcome della gravidanza (epoca gestazionale al parto, peso neonatale, Apgar score) e l’appropriatezza dell’indicazione al cerchiaggio. Risultati: nel corso dei 13 anni in studio sono stati eseguiti 191 cerchiaggi: 109 nel I gruppo, 24 nel II, 39 nel III, 13 e 6 rispettivamente nel IV e V gruppo. In un caso il cerchiaggio e’ stato eseguito per via laparoscopica prima dell’insorgenza della gravidanza. La distribuzione dei diversi tipi di cerchiaggio e’ cambiata: dal 2007 non vengono seguiti cerchiaggi in gravidanze multiple, sono diminuiti quelli elettivi e sono aumentati i cerchiaggi d’emergenza pur essendo i casi con morbilità materna maggiore: in una paziente si e’ verificato un aborto settico con shock settico materno e si e’ reso necessario un intervento di isterectomia. Conclusioni: l'applicazioni di indicazioni piu' selettive all’esecuzione del cerchiaggio hanno determinato una forte riduzione dell’utilizzo da tale procedura. L'aumento dell'utilizzo del cerchiaggio d’emergenza e' legato al fatto che rappresenta l’ultima chance per convertire un aborto inevitabile in un parto di neonato vivo in casi estremi.

Stochastic modeling of bacterial protein domains distribution to predict horizontal gene transfer

In questo elaborato, abbiamo tentato di modellizzare i processi che regolano la presenza dei domini proteici. I domini proteici studiati in questa tesi sono stati ottenuti dai genomi batterici disponibili nei data base pubblici (principalmente dal National Centre for Biotechnology Information: NCBI) tramite una procedura di simulazione computazionale. Ci siamo concentrati su organismi batterici in quanto in essi la presenza di geni trasmessi orizzontalmente, ossia che parte del materiale genetico non provenga dai genitori, e assodato che sia presente in una maggiore percentuale rispetto agli organismi più evoluti. Il modello usato si basa sui processi stocastici di nascita e morte, con l'aggiunta di un parametro di migrazione, usato anche nella descrizione dell'abbondanza relativa delle specie in ambito delle biodiversità ecologiche. Le relazioni tra i parametri, calcolati come migliori stime di una distribuzione binomiale negativa rinormalizzata e adattata agli istogrammi sperimentali, ci induce ad ipotizzare che le famiglie batteriche caratterizzate da un basso valore numerico del parametro di immigrazione abbiano contrastato questo deficit con un elevato valore del tasso di nascita. Al contrario, ipotizziamo che le famiglie con un tasso di nascita relativamente basso si siano adattate, e in conseguenza, mostrano un elevato valore del parametro di migrazione. Inoltre riteniamo che il parametro di migrazione sia direttamente proporzionale alla quantità di trasferimento genico orizzontale effettuato dalla famiglia batterica.

Un’applicazione di elaborazione del linguaggio naturale per il gioco di "Indovina chi?" su robot umanoide

La tesi è stata incentrata sul gioco «Indovina chi?» per l’identificazione da parte del robot Nao di un personaggio tramite la sua descrizione. In particolare la descrizione avviene tramite domande e risposte L’obiettivo della tesi è la progettazione di un sistema in grado di capire ed elaborare dei dati comunicati usando un sottoinsieme del linguaggio naturale, estrapolarne le informazioni chiave e ottenere un riscontro con informazioni date in precedenza. Si è quindi programmato il robot Nao in modo che sia in grado di giocare una partita di «Indovina chi?» contro un umano comunicando tramite il linguaggio naturale. Sono state implementate regole di estrazione e categorizzazione per la comprensione del testo utilizzando Cogito, una tecnologia brevettata dall'azienda Expert System. In questo modo il robot è in grado di capire le risposte e rispondere alle domande formulate dall'umano mediante il linguaggio naturale. Per il riconoscimento vocale è stata utilizzata l'API di Google e PyAudio per l'utilizzo del microfono. Il programma è stato implementato in Python e i dati dei personaggi sono memorizzati in un database che viene interrogato e modificato dal robot. L'algoritmo del gioco si basa su calcoli probabilistici di vittoria del robot e sulla scelta delle domande da proporre in base alle risposte precedentemente ricevute dall'umano. Le regole semantiche realizzate danno la possibilità al giocatore di formulare frasi utilizzando il linguaggio naturale, inoltre il robot è in grado di distinguere le informazioni che riguardano il personaggio da indovinare senza farsi ingannare. La percentuale di vittoria del robot ottenuta giocando 20 partite è stata del 50%. Il data base è stato sviluppato in modo da poter realizzare un identikit completo di una persona, oltre a quello dei personaggi del gioco. È quindi possibile ampliare il progetto per altri scopi, oltre a quello del gioco, nel campo dell'identificazione.

Survey of aspergillosis in non-neutropenic patients in Swiss teaching hospitals

Clin Microbiol Infect ABSTRACT: Invasive aspergillosis (IA) is a live-threatening opportunistic infection that is best described in haematological patients with prolonged neutropenia or graft-versus-host disease. Data on IA in non-neutropenic patients are limited. The aim of this study was to establish the incidence, disease manifestations and outcome of IA in non-neutropenic patients diagnosed in five Swiss university hospitals during a 2-year period. Case identification was based on a comprehensive screening of hospital records. All cases of proven and probable IA were retrospectively analysed. Sixty-seven patients were analysed (median age 60 years; 76% male). Sixty-three per cent of cases were invasive pulmonary aspergillosis (IPA), and 17% of these were disseminated aspergillosis. The incidence of IPA was 1.2/10?000 admissions. Six of ten cases of extrapulmonary IA affected the brain. There were six cases of invasive rhinosinusitis, six cases of chronic pulmonary aspergillosis, and cases three of subacute pulmonary aspergillosis. The most frequent underlying condition of IA was corticosteroid treatment (57%), followed by chronic lung disease (48%), and intensive-care unit stays (43%). In 38% of patients with IPA, the diagnosis was established at autopsy. Old age was the only risk factor for post-mortem diagnosis, whereas previous solid organ transplantation and chronic lung disease were associated with lower odds of post-mortem diagnosis. The mortality rate was 57%.

Separation of Ownership from Control and Discretionary Managerial Behaviour in a Transition Economy

This study was the final stage of a four-year study of managerial behaviour and company performance in Bulgaria and examined the influence of changing ownership and control structures of companies on managerial behaviour and initiative. It provides a theoretical summary of the specific types of ownership, control, governance structures and managerial strategies in the Bulgarian transitional economy during 1992-1996. It combines two theoretical approaches, the property-rights approach to show concentrated property-rights structure and private and majority types of control as determinants of efficient enterprise risk bearing and constrained managerial discretion, and the agency theory approach to reveal the efficient role of direct non-market governance mechanisms over managers. Mr. Peev also used empirical information collected from the Central Statistical office in Bulgaria, three different enterprise investigations of corporatised state-owned enterprises between 1992 and 1994, and his own data base of privatised and private de novo industrial companies in 1996-1996. The project gives a detailed description of the main property-rights structures in Bulgaria at the present time and of the various control structures related to these. It found that there is a strong owner type of control in private and privatised firms, although, contrary to expectations, 100% state -owned enterprises tended to be characterised by a separation of ownership from control, leaving scope for managerial discretion. Mr. Peev predicts that after the forthcoming mass privatisation, many companies will acquire a dispersed ownership structure and there will be a greater separation of ownership from control and potential or inefficient managerial behaviour. The next aspect considered in detail was governance structures and the influence of the generally unstable macroeconomic environment in the country during the period in question. In examining managerial strategies, Mr. Peev divided the years since 1990 into 3 periods. Even in the first period (1990-1992) there were some signs of a more efficient role for managers and between 1992 and 1994 the picture of control structures and different managerial behaviour in state-owned companies became more diversified. Managerial strategies identified included managerial initiatives for privatisation, where managers took initiative in resolving problems of property rights and introducing restructuring measures and privatisation proposals, managerial initiatives for restructuring without privatisation, and passive adjustment and passive management, where managers seek outside services for marketing, finance management, etc. in order to adjust to the new environment. During 1995-1996 some similarities and differences between the managerial behaviour of privatised and state-owned firms emerged. Firstly, the former have undergone many changes in investment and technology, while managers of state-owned companies have changed little in this field, indicating that the private property-rights structure is more efficient for the long-term adaptation of enterprises. In the area of strategies relating to product quality, marketing, and pricing policy there was little difference between managers of private, privatised and state-owned firms. The most passive managerial behaviour was found in non-incorporated state-owned firms, although these have only an insignificant stake in the economy.

Internet based multicenter study for thoracolumbar injuries: a new concept and preliminary results

This article reports about the internet based, second multicenter study (MCS II) of the spine study group (AG WS) of the German trauma association (DGU). It represents a continuation of the first study conducted between the years 1994 and 1996 (MCS I). For the purpose of one common, centralised data capture methodology, a newly developed internet-based data collection system ( http://www.memdoc.org ) of the Institute for Evaluative Research in Orthopaedic Surgery of the University of Bern was used. The aim of this first publication on the MCS II was to describe in detail the new method of data collection and the structure of the developed data base system, via internet. The goal of the study was the assessment of the current state of treatment for fresh traumatic injuries of the thoracolumbar spine in the German speaking part of Europe. For that reason, we intended to collect large number of cases and representative, valid information about the radiographic, clinical and subjective treatment outcomes. Thanks to the new study design of MCS II, not only the common surgical treatment concepts, but also the new and constantly broadening spectrum of spine surgery, i.e. vertebro-/kyphoplasty, computer assisted surgery and navigation, minimal-invasive, and endoscopic techniques, documented and evaluated. We present a first statistical overview and preliminary analysis of 18 centers from Germany and Austria that participated in MCS II. A real time data capture at source was made possible by the constant availability of the data collection system via internet access. Following the principle of an application service provider, software, questionnaires and validation routines are located on a central server, which is accessed from the periphery (hospitals) by means of standard Internet browsers. By that, costly and time consuming software installation and maintenance of local data repositories are avoided and, more importantly, cumbersome migration of data into one integrated database becomes obsolete. Finally, this set-up also replaces traditional systems wherein paper questionnaires were mailed to the central study office and entered by hand whereby incomplete or incorrect forms always represent a resource consuming problem and source of error. With the new study concept and the expanded inclusion criteria of MCS II 1, 251 case histories with admission and surgical data were collected. This remarkable number of interventions documented during 24 months represents an increase of 183% compared to the previously conducted MCS I. The concept and technical feasibility of the MEMdoc data collection system was proven, as the participants of the MCS II succeeded in collecting data ever published on the largest series of patients with spinal injuries treated within a 2 year period.

Determinants of cerebral extracellular potassium after severe human head injury

The key role players of brain swelling seen after severe human head injury have only been partly determined. We used our human head injury data base to determine relationships between potassium, glutamate, lactate and cerebral blood flow (CBF). A total of 70 severely head injured patients (GCS < or = 8) were studied using intracerebral microdialysis to measure extracellular glutamate, potassium and lactate. Xenon CT was used to determine regional cerebral blood flow (rCBF). The mean +/- SEM of the r value of all patients, between potassium and glutamate, and potassium and lactate was 0.25 +/- 0.04 (p < 0.0001) and 0.17 +/- 0.06 (p = 0.006), respectively, demonstrating in both cases a positive relationship. rCBF was negatively correlated with potassium with marginal significance (r = -0.35, p = 0.08). When separated into two groups, patients with contusion had higher potassium levels than patients without contusion (1.55 +/- 0.03 mmol/l versus 1.26 +/- 0.02 mmol/l, respectively). These results in severely head injured patients confirm previous in vitro and animal studies in which relationships between potassium, glutamate, lactate and CBF were found. Potassium efflux is a major determinant of cell swelling leading to clinically significant cytotoxic edema due to increased glutamate release during reduced cerebral blood flow.