A process evaluation of a health literacy intervention targeting pediatric providers' communication skills at the Texas Children's Health Plan

Background. Health literacy is an important determinant for quality health care, and affects communication between patients and physicians. Poor communication may result in negative effects in health. Improved communication between patients and physicians could positively affect health outcomes. Communication skills are teachable.^ Objectives. (1) to evaluate the process involved in the design and implementation of a health literacy intervention targeting pediatric providers’ communication skills at the Texas Children’s Health Plan in Houston, Texas; and (2) to describe lessons learned from this process that may be used in future attempts to address the issue of health literacy and health communication. ^ Design/methods. The process evaluation of the implementation of a health literacy strategy at the Texas Children’s Health Plan (TCHP) consisted of a critical analysis of all documents and minutes from meetings of the team of investigators. It also involved a secondary analysis of data collected between December 2006 and June 2007. Descriptive statistics, paired t-test and Wilcoxon-signed-rank test were employed in analyzing the data. This information was complemented with a limited review of existing literature on communication skills training programs. ^ Results. The design of the educational intervention followed recommendations from experts in the field of health literacy. The delivery of the intervention was possible and benefited from existing resources and logistics within the TCHP. Very few targeted providers participated in two offerings of the workshop (6.6% and 1.7% respectively). After the educational intervention, providers showed increased knowledge of health literacy facts and its effects in health (p=0.001); increased awareness of the low health literacy problem (p=0.003); increased expectations for change in practice (p=0.002), and intent to use health literacy strategies for communication immediately following the intervention (p=0.001). Low participation indicated the need for further investigation of barriers to, and means for successful implementation of programs aimed to improving health communication. ^ Conclusions. A short, focused intervention utilizing health literacy strategies for communication appeared effective in increasing knowledge and intentions for change in a small group of pediatric providers. ^

The impact of a child's unexpected hospitalization upon Taiwanese parents' situational anxiety

Background. The parents of a sick child likely experience situational anxiety due to their young child being unexpectedly hospitalized. The emotional upheaval may be great enough that their anxiety inhibits them in providing positive support to their hospitalized child. Because anxiety affects psychological distress as well as behavioral distress, identifying parental distress helps parents improving their coping mechanisms. ^ Purpose. The study compared situational anxiety levels between Taiwanese fathers and mothers and focused on differences between parental anxiety levels at the beginning of the child's unplanned hospitalization and at time of discharge. The study also identified factors related to the parents' distress and use of coping mechanisms. ^ Methods. A descriptive, comparative research design was used to determine the difference between the anxiety levels of 62 Taiwanese father-mother dyads during the situational crisis of their child's unexpected hospitalization. The Mandarin version (M) of Visual Analog Scale (VAS-M), State-Trait Anxiety Inventory (STAI-M), and the Index of Parent Participation/Hospitalized Child (IPP/HC-M) were used to differentiate maternal and paternal anxiety levels and identify factors related to the parents' distress. Questionnaires were completed by parents within 24-36 hours of the child's hospital admission and within 24 hours prior to discharge. A paired t-test, two sample t-test, and linear mixed regression model were used to test and support the study hypothesis. ^ Results. The findings reveal that the mothers' anxiety levels did not significantly differ from the fathers' anxiety level when their child had a sudden admission to the hospital. In particular, parental state anxiety levels did not decrease during the child's hospital stay and subsequent discharge. Moreover, anxiety levels did not differ between parents regardless of whether the child's disease was acute or chronic. The most effective factor related to parental situational anxiety was parental perception of the severity of the child's illness. ^ Conclusions. Parental anxiety was found to be significantly related to changes in their perception of the severity of their child's illness. However, the study was not able to illustrate how parental involvement in the child's hospital care was related to parental perception of the severity of their child's illness. Future studies, using a qualitative approach to gamer more information as to what variables influence parental anxiety during a situational crisis, may provide a richer database from which to modify key variables as well as the instruments used to improve the quality of the data obtained. ^

Assessing time-by-covariate interactions in Cox proportional hazards regression models using cubic spline functions

This dissertation develops and explores the methodology for the use of cubic spline functions in assessing time-by-covariate interactions in Cox proportional hazards regression models. These interactions indicate violations of the proportional hazards assumption of the Cox model. Use of cubic spline functions allows for the investigation of the shape of a possible covariate time-dependence without having to specify a particular functional form. Cubic spline functions yield both a graphical method and a formal test for the proportional hazards assumption as well as a test of the nonlinearity of the time-by-covariate interaction. Five existing methods for assessing violations of the proportional hazards assumption are reviewed and applied along with cubic splines to three well known two-sample datasets. An additional dataset with three covariates is used to explore the use of cubic spline functions in a more general setting. ^

Cataract surgery in cancer patients and its impact on quality of life as measured by the National Eye Institute Visual Functioning Questionnaire - 25 (NEI-VFQ-25)

Purpose. The measurement of quality of life has become an important topic in healthcare and in the allocation of limited healthcare resources. Improving the quality of life (QOL) in cancer patients is paramount. Cataract removal and lens implantation appears to improve patient well-being of cancer patients, though a formal measurement has never been published in the US literature. In this current study, National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), a validated vision quality of life metric, was used to study the change in vision-related quality of life in cancer patients who underwent cataract extraction with intraocular lens implantation. ^ Methods. Under an IRB approved protocol, cancer patients who underwent cataract surgery with intraocular lens implantation (by a single surgeon) from December 2008 to March 2011, and who had completed a pre- and postoperative NEI-VFQ-25 were retrospectively reviewed. Post-operative data was collected at their routine 4-6 week post-op visit. Patients' demographics, cancer history, their pre and postoperative ocular examinations, visual acuities, and NEI-VFQ-25 with twelve components were included in the evaluation. The responses were evaluated using the Student t test, Spearman correlation and Wilcoxon signed rank test. ^ Results. 63 cases of cataract surgery (from 54 patients) from the MD Anderson Cancer Center were included in the study. Cancer patients had a significant improvement in the visual acuity (P<0.0001) postoperatively, along with a significant increase in vision-related quality of life (P<0.0001). Patients also had a statistically significant improvement in ten of the twelve subcategories which are addressed in the NEI-VFQ-25. ^ Conclusions. In our study, cataract extraction and intraocular implantation showed a significant impact on the vision-related quality of life in cancer patients. Although this study includes a small sample size, it serves as a positive pilot study to evaluate and quantify the impact of a surgical intervention on QOL in cancer patients and may help to design a larger study to measure vision related QOL per dollar spent for health care cost in cancer patients.^

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

Purpose: Surgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to five tasks included in SINERGIA laparoscopic virtual reality simulator. Methods: Thirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1–R8) of the five mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of R1, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value <0.005. Results: In total, 84.38% of the metrics provided by SINERGIA and included in this study show significant differences when comparing R1 and R8. Metrics are mostly improved in the first session of training (75.00% when R1 and R4 are compared vs. 37.50% when R4 and R8 are compared). In tasks Coordination and Navigation and touch, all metrics are improved. On the other hand, Navigation just improves 60% of the analyzed metrics. Most learning curves show an improvement with better results in the fulfillment of the different tasks. Conclusions: Learning curves of metrics that assess the basic psychomotor laparoscopic skills acquired in SINERGIA virtual reality simulator show a faster learning rate during the first part of the training. Nevertheless, eight repetitions of the tasks are not enough to acquire all psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program.

Evaluación estocástica de huecos de tensión en sistemas eléctricos: estudio de sensibilidad, estimación de índices y localización óptima de medidores

I. GENERALIDADES 1.1. Introducción Entre los diversos tipos de perturbaciones eléctricas, los huecos de tensión son considerados el problema de calidad de suministro más frecuente en los sistemas eléctricos. Este fenómeno es originado por un aumento extremo de la corriente en el sistema, causado principalmente por cortocircuitos o maniobras inadecuadas en la red. Este tipo de perturbación eléctrica está caracterizado básicamente por dos parámetros: tensión residual y duración. Típicamente, se considera que el hueco se produce cuando la tensión residual alcanza en alguna de las fases un valor entre 0.01 a 0.9 pu y tiene una duración de hasta 60 segundos. Para un usuario final, el efecto más relevante de un hueco de tensión es la interrupción o alteración de la operación de sus equipos, siendo los dispositivos de naturaleza electrónica los principalmente afectados (p. ej. ordenador, variador de velocidad, autómata programable, relé, etc.). Debido al auge tecnológico de las últimas décadas y a la búsqueda constante de automatización de los procesos productivos, el uso de componentes electrónicos resulta indispensable en la actualidad. Este hecho, lleva a que los efectos de los huecos de tensión sean más evidentes para el usuario final, provocando que su nivel de exigencia de la calidad de energía suministrada sea cada vez mayor. De forma general, el estudio de los huecos de tensión suele ser abordado bajo dos enfoques: en la carga o en la red. Desde el punto de vista de la carga, se requiere conocer las características de sensibilidad de los equipos para modelar su respuesta ante variaciones súbitas de la tensión del suministro eléctrico. Desde la perspectiva de la red, se busca estimar u obtener información adecuada que permita caracterizar su comportamiento en términos de huecos de tensión. En esta tesis, el trabajo presentado se encuadra en el segundo aspecto, es decir, en el modelado y estimación de la respuesta de un sistema eléctrico de potencia ante los huecos de tensión. 1.2. Planteamiento del problema A pesar de que los huecos de tensión son el problema de calidad de suministro más frecuente en las redes, hasta la actualidad resulta complejo poder analizar de forma adecuada este tipo de perturbación para muchas compañías del sector eléctrico. Entre las razones más comunes se tienen: - El tiempo de monitorización puede llegar a ser de varios años para conseguir una muestra de registros de huecos estadísticamente válida. - La limitación de recursos económicos para la adquisición e instalación de equipos de monitorización de huecos. - El elevado coste operativo que implica el análisis de los datos de los medidores de huecos de tensión instalados. - La restricción que tienen los datos de calidad de energía de las compañías eléctricas. Es decir, ante la carencia de datos que permitan analizar con mayor detalle los huecos de tensión, es de interés de las compañías eléctricas y la academia poder crear métodos fiables que permitan profundizar en el estudio, estimación y supervisión de este fenómeno electromagnético. Los huecos de tensión, al ser principalmente originados por eventos fortuitos como los cortocircuitos, son el resultado de diversas variables exógenas como: (i) la ubicación de la falta, (ii) la impedancia del material de contacto, (iii) el tipo de fallo, (iv) la localización del fallo en la red, (v) la duración del evento, etc. Es decir, para plantear de forma adecuada cualquier modelo teórico sobre los huecos de tensión, se requeriría representar esta incertidumbre combinada de las variables para proveer métodos realistas y, por ende, fiables para los usuarios. 1.3. Objetivo La presente tesis ha tenido como objetivo el desarrollo diversos métodos estocásticos para el estudio, estimación y supervisión de los huecos de tensión en los sistemas eléctricos de potencia. De forma específica, se ha profundizado en los siguientes ámbitos: - En el modelado realista de las variables que influyen en la caracterización de los huecos. Esto es, en esta Tesis se ha propuesto un método que permite representar de forma verosímil su cuantificación y aleatoriedad en el tiempo empleando distribuciones de probabilidad paramétricas. A partir de ello, se ha creado una herramienta informática que permite estimar la severidad de los huecos de tensión en un sistema eléctrico genérico. - Se ha analizado la influencia la influencia de las variables de entrada en la estimación de los huecos de tensión. En este caso, el estudio se ha enfocado en las variables de mayor divergencia en su caracterización de las propuestas existentes. - Se ha desarrollado un método que permite estima el número de huecos de tensión de una zona sin monitorización a través de la información de un conjunto limitado de medidas de un sistema eléctrico. Para ello, se aplican los principios de la estadística Bayesiana, estimando el número de huecos de tensión más probable de un emplazamiento basándose en los registros de huecos de otros nudos de la red. - Plantear una estrategia para optimizar la monitorización de los huecos de tensión en un sistema eléctrico. Es decir, garantizar una supervisión del sistema a través de un número de medidores menor que el número de nudos de la red. II. ESTRUCTURA DE LA TESIS Para plantear las propuestas anteriormente indicadas, la presente Tesis se ha estructurado en seis capítulos. A continuación, se describen brevemente los mismos. A manera de capítulo introductorio, en el capítulo 1, se realiza una descripción del planteamiento y estructura de la presente tesis. Esto es, se da una visión amplia de la problemática a tratar, además de describir el alcance de cada capítulo de la misma. En el capítulo 2, se presenta una breve descripción de los fundamentos y conceptos generales de los huecos de tensión. Los mismos, buscan brindar al lector de una mejor comprensión de los términos e indicadores más empleados en el análisis de severidad de los huecos de tensión en las redes eléctricas. Asimismo, a manera de antecedente, se presenta un resumen de las principales características de las técnicas o métodos existentes aplicados en la predicción y monitorización óptima de los huecos de tensión. En el capítulo 3, se busca fundamentalmente conocer la importancia de las variables que determinen la frecuencia o severidad de los huecos de tensión. Para ello, se ha implementado una herramienta de estimación de huecos de tensión que, a través de un conjunto predeterminado de experimentos mediante la técnica denominada Diseño de experimentos, analiza la importancia de la parametrización de las variables de entrada del modelo. Su análisis, es realizado mediante la técnica de análisis de la varianza (ANOVA), la cual permite establecer con rigor matemático si la caracterización de una determinada variable afecta o no la respuesta del sistema en términos de los huecos de tensión. En el capítulo 4, se propone una metodología que permite predecir la severidad de los huecos de tensión de todo el sistema a partir de los registros de huecos de un conjunto reducido de nudos de dicha red. Para ello, se emplea el teorema de probabilidad condicional de Bayes, el cual calcula las medidas más probables de todo el sistema a partir de la información proporcionada por los medidores de huecos instalados. Asimismo, en este capítulo se revela una importante propiedad de los huecos de tensión, como es la correlación del número de eventos de huecos de tensión en diversas zonas de las redes eléctricas. En el capítulo 5, se desarrollan dos métodos de localización óptima de medidores de huecos de tensión. El primero, que es una evolución metodológica del criterio de observabilidad; aportando en el realismo de la pseudo-monitorización de los huecos de tensión con la que se calcula el conjunto óptimo de medidores y, por ende, en la fiabilidad del método. Como una propuesta alternativa, se emplea la propiedad de correlación de los eventos de huecos de tensión de una red para plantear un método que permita establecer la severidad de los huecos de todo el sistema a partir de una monitorización parcial de dicha red. Finalmente, en el capítulo 6, se realiza una breve descripción de las principales aportaciones de los estudios realizados en esta tesis. Adicionalmente, se describen diversos temas a desarrollar en futuros trabajos. III. RESULTADOS En base a las pruebas realizadas en las tres redes planteadas; dos redes de prueba IEEE de 24 y 118 nudos (IEEE-24 e IEEE-118), además del sistema eléctrico de la República del Ecuador de 357 nudos (EC-357), se describen los siguientes puntos como las observaciones más relevantes: A. Estimación de huecos de tensión en ausencia de medidas: Se implementa un método estocástico de estimación de huecos de tensión denominado PEHT, el cual representa con mayor realismo la simulación de los eventos de huecos de un sistema a largo plazo. Esta primera propuesta de la tesis, es considerada como un paso clave para el desarrollo de futuros métodos del presente trabajo, ya que permite emular de forma fiable los registros de huecos de tensión a largo plazo en una red genérica. Entre las novedades más relevantes del mencionado Programa de Estimación de Huecos de Tensión (PEHT) se tienen: - Considerar el efecto combinado de cinco variables aleatorias de entrada para simular los eventos de huecos de tensión en una pseudo-monitorización a largo plazo. Las variables de entrada modeladas en la caracterización de los huecos de tensión en el PEHT son: (i) coeficiente de fallo, (ii) impedancia de fallo, (iii) tipo de fallo, (iv) localización del fallo y (v) duración. - El modelado estocástico de las variables de entrada impedancia de fallo y duración en la caracterización de los eventos de huecos de tensión. Para la parametrización de las variables mencionadas, se realizó un estudio detallado del comportamiento real de las mismas en los sistemas eléctricos. Asimismo, se define la función estadística que mejor representa la naturaleza aleatoria de cada variable. - Considerar como variables de salida del PEHT a indicadores de severidad de huecos de uso común en las normativas, como es el caso de los índices: SARFI-X, SARFI-Curve, etc. B. Análisis de sensibilidad de los huecos de tensión: Se presenta un estudio causa-efecto (análisis de sensibilidad) de las variables de entrada de mayor divergencia en su parametrización entre las referencias relacionadas a la estimación de los huecos de tensión en redes eléctricas. De forma específica, se profundiza en el estudio de la influencia de la parametrización de las variables coeficiente de fallo e impedancia de fallo en la predicción de los huecos de tensión. A continuación un resumen de las conclusiones más destacables: - La precisión de la variable de entrada coeficiente de fallo se muestra como un parámetro no influyente en la estimación del número de huecos de tensión (SARFI-90 y SARFI-70) a largo plazo. Es decir, no se requiere de una alta precisión del dato tasa de fallo de los elementos del sistema para obtener una adecuada estimación de los huecos de tensión. - La parametrización de la variable impedancia de fallo se muestra como un factor muy sensible en la estimación de la severidad de los huecos de tensión. Por ejemplo, al aumentar el valor medio de esta variable aleatoria, se disminuye considerablemente la severidad reportada de los huecos en la red. Por otra parte, al evaluar el parámetro desviación típica de la impedancia de fallo, se observa una relación directamente proporcional de este parámetro con la severidad de los huecos de tensión de la red. Esto es, al aumentar la desviación típica de la impedancia de fallo, se evidencia un aumento de la media y de la variación interanual de los eventos SARFI-90 y SARFI-70. - En base al análisis de sensibilidad desarrollado en la variable impedancia de fallo, se considera muy cuestionable la fiabilidad de los métodos de estimación de huecos de tensión que omiten su efecto en el modelo planteado. C. Estimación de huecos de tensión en base a la información de una monitorización parcial de la red: Se desarrolla un método que emplea los registros de una red parcialmente monitorizada para determinar la severidad de los huecos de todo el sistema eléctrico. A partir de los casos de estudio realizados, se observa que el método implementado (PEHT+MP) posee las siguientes características: - La metodología propuesta en el PEHT+MP combina la teoría clásica de cortocircuitos con diversas técnicas estadísticas para estimar, a partir de los datos de los medidores de huecos instalados, las medidas de huecos de los nudos sin monitorización de una red genérica. - El proceso de estimación de los huecos de tensión de la zona no monitorizada de la red se fundamenta en la aplicación del teorema de probabilidad condicional de Bayes. Es decir, en base a los datos observados (los registros de los nudos monitorizados), el PEHT+MP calcula de forma probabilística la severidad de los huecos de los nudos sin monitorización del sistema. Entre las partes claves del procedimiento propuesto se tienen los siguientes puntos: (i) la creación de una base de datos realista de huecos de tensión a través del Programa de Estimación de Huecos de Tensión (PEHT) propuesto en el capítulo anterior; y, (ii) el criterio de máxima verosimilitud empleado para estimar las medidas de huecos de los nudos sin monitorización de la red evaluada. - Las predicciones de medidas de huecos de tensión del PEHT+MP se ven potenciadas por la propiedad de correlación de los huecos de tensión en diversas zonas de un sistema eléctrico. Esta característica intrínseca de las redes eléctricas limita de forma significativa la respuesta de las zonas fuertemente correlacionadas del sistema ante un eventual hueco de tensión. Como el PEHT+MP está basado en principios probabilísticos, la reducción del rango de las posibles medidas de huecos se ve reflejado en una mejor predicción de las medidas de huecos de la zona no monitorizada. - Con los datos de un conjunto de medidores relativamente pequeño del sistema, es posible obtener estimaciones precisas (error nulo) de la severidad de los huecos de la zona sin monitorizar en las tres redes estudiadas. - El PEHT+MP se puede aplicar a diversos tipos de indicadores de severidad de los huecos de tensión, como es el caso de los índices: SARFI-X, SARFI-Curve, SEI, etc. D. Localización óptima de medidores de huecos de tensión: Se plantean dos métodos para ubicar de forma estratégica al sistema de monitorización de huecos en una red genérica. La primera propuesta, que es una evolución metodológica de la localización óptima de medidores de huecos basada en el criterio de observabilidad (LOM+OBS); y, como segunda propuesta, un método que determina la localización de los medidores de huecos según el criterio del área de correlación (LOM+COR). Cada método de localización óptima de medidores propuesto tiene un objetivo concreto. En el caso del LOM+OBS, la finalidad del método es determinar el conjunto óptimo de medidores que permita registrar todos los fallos que originen huecos de tensión en la red. Por otro lado, en el método LOM+COR se persigue definir un sistema óptimo de medidores que, mediante la aplicación del PEHT+MP (implementado en el capítulo anterior), sea posible estimar de forma precisa las medidas de huecos de tensión de todo el sistema evaluado. A partir del desarrollo de los casos de estudio de los citados métodos de localización óptima de medidores en las tres redes planteadas, se describen a continuación las observaciones más relevantes: - Como la generación de pseudo-medidas de huecos de tensión de los métodos de localización óptima de medidores (LOM+OBS y LOM+COR) se obtienen mediante la aplicación del algoritmo PEHT, la formulación del criterio de optimización se realiza en base a una pseudo-monitorización realista, la cual considera la naturaleza aleatoria de los huecos de tensión a través de las cinco variables estocásticas modeladas en el PEHT. Esta característica de la base de datos de pseudo-medidas de huecos de los métodos LOM+OBS y LOM+COR brinda una mayor fiabilidad del conjunto óptimo de medidores calculado respecto a otros métodos similares en la bibliografía. - El conjunto óptimo de medidores se determina según la necesidad del operador de la red. Esto es, si el objetivo es registrar todos los fallos que originen huecos de tensión en el sistema, se emplea el criterio de observabilidad en la localización óptima de medidores de huecos. Por otra parte, si se plantea definir un sistema de monitorización que permita establecer la severidad de los huecos de tensión de todo el sistema en base a los datos de un conjunto reducido de medidores de huecos, el criterio de correlación resultaría el adecuado. De forma específica, en el caso del método LOM+OBS, basado en el criterio de observabilidad, se evidenciaron las siguientes propiedades en los casos de estudio realizados: - Al aumentar el tamaño de la red, se observa la tendencia de disminuir el porcentaje de nudos monitorizados de dicho sistema. Por ejemplo, para monitorizar los fallos que originan huecos en la red IEEE-24, se requiere monitorizar el 100\% de los nudos del sistema. En el caso de las redes IEEE-118 y EC-357, el método LOM+OBS determina que con la monitorización de un 89.5% y 65.3% del sistema, respectivamente, se cumpliría con el criterio de observabilidad del método. - El método LOM+OBS permite calcular la probabilidad de utilización del conjunto óptimo de medidores a largo plazo, estableciendo así un criterio de la relevancia que tiene cada medidor considerado como óptimo en la red. Con ello, se puede determinar el nivel de precisión u observabilidad (100%, 95%, etc.) con el cual se detectarían los fallos que generan huecos en la red estudiada. Esto es, al aumentar el nivel de precisión de detección de los fallos que originan huecos, se espera que aumente el número de medidores requeridos en el conjunto óptimo de medidores calculado. - El método LOM+OBS se evidencia como una técnica aplicable a todo tipo de sistema eléctrico (radial o mallado), el cual garantiza la detección de los fallos que originan huecos de tensión en un sistema según el nivel de observabilidad planteado. En el caso del método de localización óptima de medidores basado en el criterio del área de correlación (LOM+COR), las diversas pruebas realizadas evidenciaron las siguientes conclusiones: - El procedimiento del método LOM+COR combina los métodos de estimación de huecos de tensión de capítulos anteriores (PEHT y PEHT+MP) con técnicas de optimización lineal para definir la localización óptima de los medidores de huecos de tensión de una red. Esto es, se emplea el PEHT para generar los pseudo-registros de huecos de tensión, y, en base al criterio planteado de optimización (área de correlación), el LOM+COR formula y calcula analíticamente el conjunto óptimo de medidores de la red a largo plazo. A partir de la información registrada por este conjunto óptimo de medidores de huecos, se garantizaría una predicción precisa de la severidad de los huecos de tensión de todos los nudos del sistema con el PEHT+MP. - El método LOM+COR requiere un porcentaje relativamente reducido de nudos del sistema para cumplir con las condiciones de optimización establecidas en el criterio del área de correlación. Por ejemplo, en el caso del número total de huecos (SARFI-90) de las redes IEEE-24, IEEE-118 y EC-357, se calculó un conjunto óptimo de 9, 12 y 17 medidores de huecos, respectivamente. Es decir, solamente se requeriría monitorizar el 38\%, 10\% y 5\% de los sistemas indicados para supervisar los eventos SARFI-90 en toda la red. - El método LOM+COR se muestra como un procedimiento de optimización versátil, el cual permite reducir la dimensión del sistema de monitorización de huecos de redes eléctricas tanto radiales como malladas. Por sus características, este método de localización óptima permite emular una monitorización integral del sistema a través de los registros de un conjunto pequeño de monitores. Por ello, este nuevo método de optimización de medidores sería aplicable a operadores de redes que busquen disminuir los costes de instalación y operación del sistema de monitorización de los huecos de tensión. ABSTRACT I. GENERALITIES 1.1. Introduction Among the various types of electrical disturbances, voltage sags are considered the most common quality problem in power systems. This phenomenon is caused by an extreme increase of the current in the network, primarily caused by short-circuits or inadequate maneuvers in the system. This type of electrical disturbance is basically characterized by two parameters: residual voltage and duration. Typically, voltage sags occur when the residual voltage, in some phases, reaches a value between 0.01 to 0.9 pu and lasts up to 60 seconds. To an end user, the most important effect of a voltage sags is the interruption or alteration of their equipment operation, with electronic devices the most affected (e.g. computer, drive controller, PLC, relay, etc.). Due to the technology boom of recent decades and the constant search for automating production processes, the use of electronic components is essential today. This fact makes the effects of voltage sags more noticeable to the end user, causing the level of demand for a quality energy supply to be increased. In general, the study of voltage sags is usually approached from one of two aspects: the load or the network. From the point of view of the load, it is necessary to know the sensitivity characteristics of the equipment to model their response to sudden changes in power supply voltage. From the perspective of the network, the goal is to estimate or obtain adequate information to characterize the network behavior in terms of voltage sags. In this thesis, the work presented fits into the second aspect; that is, in the modeling and estimation of the response of a power system to voltage sag events. 1.2. Problem Statement Although voltage sags are the most frequent quality supply problem in electrical networks, thistype of disturbance remains complex and challenging to analyze properly. Among the most common reasons for this difficulty are: - The sag monitoring time, because it can take up to several years to get a statistically valid sample. - The limitation of funds for the acquisition and installation of sag monitoring equipment. - The high operating costs involved in the analysis of the voltage sag data from the installed monitors. - The restrictions that electrical companies have with the registered power quality data. That is, given the lack of data to further voltage sag analysis, it is of interest to electrical utilities and researchers to create reliable methods to deepen the study, estimation and monitoring of this electromagnetic phenomenon. Voltage sags, being mainly caused by random events such as short-circuits, are the result of various exogenous variables such as: (i) the number of faults of a system element, (ii) the impedance of the contact material, (iii) the fault type, (iv) the fault location, (v) the duration of the event, etc. That is, to properly raise any theoretical model of voltage sags, it is necessary to represent the combined uncertainty of variables to provide realistic methods that are reliable for users. 1.3. Objective This Thesis has been aimed at developing various stochastic methods for the study, estimation and monitoring of voltage sags in electrical power systems. Specifically, it has deepened the research in the following areas: - This research furthers knowledge in the realistic modeling of the variables that influence sag characterization. This thesis proposes a method to credibly represent the quantification and randomness of the sags in time by using parametric probability distributions. From this, a software tool was created to estimate the severity of voltage sags in a generic power system. - This research also analyzes the influence of the input variables in the estimation of voltage sags. In this case, the study has focused on the variables of greatest divergence in their characterization of the existing proposals. - A method was developed to estimate the number of voltage sags of an area without monitoring through the information of a limited set of sag monitors in an electrical system. To this end, the principles of Bayesian statistics are applied, estimating the number of sags most likely to happen in a system busbar based in records of other sag network busbars. - A strategy was developed to optimize the monitorization of voltage sags on a power system. Its purpose is to ensure the monitoring of the system through a number of monitors lower than the number of busbars of the network assessed. II. THESIS STRUCTURE To describe in detail the aforementioned proposals, this Thesis has been structured into six chapters. Below is are brief descriptions of them: As an introductory chapter, Chapter 1, provides a description of the approach and structure of this thesis. It presents a wide view of the problem to be treated, in addition to the description of the scope of each chapter. In Chapter 2, a brief description of the fundamental and general concepts of voltage sags is presented to provide to the reader a better understanding of the terms and indicators used in the severity analysis of voltage sags in power networks. Also, by way of background, a summary of the main features of existing techniques or methods used in the prediction and optimal monitoring of voltage sags is also presented. Chapter 3 essentially seeks to know the importance of the variables that determine the frequency or severity of voltage sags. To do this, a tool to estimate voltage sags is implemented that, through a predetermined set of experiments using the technique called Design of Experiments, discusses the importance of the parameters of the input variables of the model. Its analysis is interpreted by using the technique of analysis of variance (ANOVA), which provides mathematical rigor to establish whether the characterization of a particular variable affects the system response in terms of voltage sags or not. In Chapter 4, a methodology to predict the severity of voltage sags of an entire system through the sag logs of a reduced set of monitored busbars is proposed. For this, the Bayes conditional probability theorem is used, which calculates the most likely sag severity of the entire system from the information provided by the installed monitors. Also, in this chapter an important property of voltage sags is revealed, as is the correlation of the voltage sags events in several zones of a power system. In Chapter 5, two methods of optimal location of voltage sag monitors are developed. The first one is a methodological development of the observability criteria; it contributes to the realism of the sag pseudo-monitoring with which the optimal set of sag monitors is calculated and, therefore, to the reliability of the proposed method. As an alternative proposal, the correlation property of the sag events of a network is used to raise a method that establishes the sag severity of the entire system from a partial monitoring of the network. Finally, in Chapter 6, a brief description of the main contributions of the studies in this Thesis is detailed. Additionally, various themes to be developed in future works are described. III. RESULTS. Based on tests on the three networks presented, two IEEE test networks of 24 and 118 busbars (IEEE-24 and IEEE-118) and the electrical system of the Republic of Ecuador (EC-357), the following points present the most important observations: A. Estimation of voltage sags in the absence of measures: A stochastic estimation method of voltage sags, called PEHT, is implemented to represent with greater realism the long-term simulation of voltage sags events in a system. This first proposal of this thesis is considered a key step for the development of future methods of this work, as it emulates in a reliable manner the voltage sag long-term records in a generic network. Among the main innovations of this voltage sag estimation method are the following: - Consideration of the combined effect of five random input variables to simulate the events of voltage sags in long-term monitoring is included. The input variables modeled in the characterization of voltage sags on the PEHT are as follows: (i) fault coefficient, (ii) fault impedance, (iii) type of fault, (iv) location of the fault, and (v) fault duration. - Also included is the stochastic modeling of the input variables of fault impedance and duration in the characterization of the events of voltage sags. For the parameterization of these variables, a detailed study of the real behavior in power systems is developed. Also, the statistical function best suited to the random nature of each variable is defined. - Consideration of sag severity indicators used in standards as PEHT output variables, including such as indices as SARFI-X, SARFI-Curve, etc. B. Sensitivity analysis of voltage sags: A cause-effect study (sensitivity analysis) of the input variables of greatest divergence between reference parameterization related to the estimation of voltage sags in electrical networks is presented. Specifically, it delves into the study of the influence of the parameterization of the variables fault coefficient and fault impedance in the voltage sag estimation. Below is a summary of the most notable observations: - The accuracy of the input variable fault coefficient is shown as a non-influential parameter in the long-term estimation of the number of voltage sags (SARFI-90 and SARFI-70). That is, it does not require a high accuracy of the fault rate data of system elements for a proper voltage sag estimation. - The parameterization of the variable fault impedance is shown to be a very sensitive factor in the estimation of the voltage sag severity. For example, by increasing the average value of this random variable, the reported sag severity in the network significantly decreases. Moreover, in assessing the standard deviation of the fault impedance parameter, a direct relationship of this parameter with the voltage sag severity of the network is observed. That is, by increasing the fault impedance standard deviation, an increase of the average and the interannual variation of the SARFI-90 and SARFI-70 events is evidenced. - Based on the sensitivity analysis developed in the variable fault impedance, the omission of this variable in the voltage sag estimation would significantly call into question the reliability of the responses obtained. C. Voltage sag estimation from the information of a network partially monitored: A method that uses the voltage sag records of a partially monitored network for the sag estimation of all the power system is developed. From the case studies performed, it is observed that the method implemented (PEHT+MP) has the following characteristics: - The methodology proposed in the PEHT+MP combines the classical short-circuit theory with several statistical techniques to estimate, from data the of the installed sag meters, the sag measurements of unmonitored busbars of a generic power network. - The estimation process of voltage sags of the unmonitored zone of the network is based on the application of the conditional probability theorem of Bayes. That is, based on the observed data (monitored busbars records), the PEHT+MP calculates probabilistically the sag severity at unmonitored system busbars. Among the key parts of the proposed procedure are the following: (i) the creation of a realistic data base of voltage sags through of the sag estimation program (PEHT); and, (ii) the maximum likelihood criterion used to estimate the sag indices of system busbars without monitoring. - The voltage sag measurement estimations of PEHT+MP are potentiated by the correlation property of the sag events in power systems. This inherent characteristic of networks significantly limits the response of strongly correlated system zones to a possible voltage sag. As the PEHT+MP is based on probabilistic principles, a reduction of the range of possible sag measurements is reflected in a better sag estimation of the unmonitored area of the power system. - From the data of a set of monitors representing a relatively small portion of the system, to obtain accurate estimations (null error) of the sag severity zones without monitoring is feasible in the three networks studied. - The PEHT+MP can be applied to several types of sag indices, such as: SARFI-X, SARFI-Curve, SEI, etc. D. Optimal location of voltage sag monitors in power systems: Two methods for strategically locating the sag monitoring system are implemented for a generic network. The first proposal is a methodological development of the optimal location of sag monitors based on the observability criterion (LOM + OBS); the second proposal is a method that determines the sag monitor location according to the correlation area criterion (LOM+COR). Each proposed method of optimal location of sag monitors has a specific goal. In the case of LOM+OBS, the purpose of the method is to determine the optimal set of sag monitors to record all faults that originate voltage sags in the network. On the other hand, the LOM+COR method attempts to define the optimal location of sag monitors to estimate the sag indices in all the assessed network with the PEHT+MP application. From the development of the case studies of these methods of optimal location of sag monitors in the three networks raised, the most relevant observations are described below: - As the generation of voltage sag pseudo-measurements of the optimal location methods (LOM+OBS and LOM+COR) are obtained by applying the algorithm PEHT, the formulation of the optimization criterion is performed based on a realistic sag pseudo-monitoring, which considers the random nature of voltage sags through the five stochastic variables modeled in PEHT. This feature of the database of sag pseudo-measurements of the LOM+OBS and LOM+COR methods provides a greater reliability of the optimal set of monitors calculated when compared to similar methods in the bibliography. - The optimal set of sag monitors is determined by the network operator need. That is, if the goal is to record all faults that originate from voltage sags in the system, the observability criterion is used to determine the optimal location of sag monitors (LOM+OBS). Moreover, if the objective is to define a monitoring system that allows establishing the sag severity of the system from taken from information based on a limited set of sag monitors, the correlation area criterion would be appropriate (LOM+COR). Specifically, in the case of the LOM+OBS method (based on the observability criterion), the following properties were observed in the case studies: - By increasing the size of the network, there was observed a reduction in the percentage of monitored system busbars required. For example, to monitor all the faults which cause sags in the IEEE-24 network, then 100% of the system busbars are required for monitoring. In the case of the IEEE-118 and EC-357 networks, the method LOM+OBS determines that with monitoring 89.5 % and 65.3 % of the system, respectively, the observability criterion of the method would be fulfilled. - The LOM+OBS method calculates the probability of using the optimal set of sag monitors in the long term, establishing a relevance criterion of each sag monitor considered as optimal in the network. With this, the level of accuracy or observability (100%, 95%, etc.) can be determined, with which the faults that caused sags in the studied network are detected. That is, when the accuracy level for detecting faults that cause sags in the system is increased, a larger number of sag monitors is expected when calculating the optimal set of monitors. - The LOM + OBS method is demonstrated to be a technique applicable to any type of electrical system (radial or mesh), ensuring the detection of faults that cause voltage sags in a system according to the observability level raised. In the case of the optimal localization of sag monitors based on the criterion of correlation area (LOM+COR), several tests showed the following conclusions: - The procedure of LOM+COR method combines the implemented algorithms of voltage sag estimation (PEHT and PEHT+MP) with linear optimization techniques to define the optimal location of the sag monitors in a network. That is, the PEHT is used to generate the voltage sag pseudo-records, and, from the proposed optimization criterion (correlation area), the LOM+COR formulates and analytically calculates the optimal set of sag monitors of the network in the long term. From the information recorded by the optimal set of sag monitors, an accurate prediction of the voltage sag severity at all the busbars of the system is guaranteed with the PEHT+MP. - The LOM + COR method is shown to be a versatile optimization procedure, which reduces the size of the sag monitoring system both at radial as meshed grids. Due to its characteristics, this optimal location method allows emulation of complete system sag monitoring through the records of a small optimal set of sag monitors. Therefore, this new optimization method would be applicable to network operators that looks to reduce the installation and operation costs of the voltage sag monitoring system.

Sobrevida de mulheres e homens com 60 anos e mais no município de São Paulo - Estudo SABE: as diferenças nas semelhanças em características do curso de vida

Objetivos: Avaliar numa coorte de idosos se há diferenças entre as situações do curso de vida que contribuem para uma maior chance de sobrevida em homens e mulheres com 60 anos e mais. Métodos: 2.143 idosos entrevistados em 2000 foram acompanhados durante quase 15 anos. Utilizou-se na análise estatística o teste de associação para amostras complexas (Rao-Scott), o estimador produto limite de Kaplan-Meier, o teste de log-rank, análise univariada e multivariada do modelo de riscos proporcionais de Cox, sendo construídos, através deste último, dois modelos finais por gênero, ao nível de significância de 5 por cento . Resultados e discussão: Dos 836.204 idosos paulistanos representados pelo estudo 51,6 por cento continuavam vivos (43,0 por cento dos homens e 57,7 por cento das mulheres). Em ambos os gêneros, os/as que tinham boas condições materiais e que realizavam sem dificuldade e sem ajuda mais da metade das atividades básicas e instrumentais de vida diária (ABVD/AIVD) apresentaram maior chance de sobrevivência. O mesmo foi verificado naquelas mulheres com menos de duas limitações de determinadas doenças, nas casadas, nas que ofereciam algum tipo de ajuda e nas que realizaram ações preventivas em relação a sua condição de saúde. Entre os homens o mesmo ocorreu naqueles que se referiram ser chefe de família, nos que tinham participação comunitária, nos que residiam com algum outro morador que foi ou ia à escola, que trabalharam predominantemente como proprietário ou por conta própria e nos que relataram ter tido alguma doença em seus primeiros quinzes anos de vida. Conclusão: As chances de sobrevida são diferentes entre gêneros, e entre si, mesmo em situações aparentemente semelhantes do curso de vida vivenciados e presentes em homens e mulheres idosas.

Uncovering the root cause of ethnic difference in ability testing:differential test functioning, test familiarity and trait optimism as explanations of ethnic group differences

The present research represents a coherent approach to understanding the root causes of ethnic group differences in ability test performance. Two studies were conducted, each of which was designed to address a key knowledge gap in the ethnic bias literature. In Study 1, both the LR Method of Differential Item Functioning (DIF) detection and Mixture Latent Variable Modelling were used to investigate the degree to which Differential Test Functioning (DTF) could explain ethnic group test performance differences in a large, previously unpublished dataset. Though mean test score differences were observed between a number of ethnic groups, neither technique was able to identify ethnic DTF. This calls into question the practical application of DTF to understanding these group differences. Study 2 investigated whether a number of non-cognitive factors might explain ethnic group test performance differences on a variety of ability tests. Two factors – test familiarity and trait optimism – were able to explain a large proportion of ethnic group test score differences. Furthermore, test familiarity was found to mediate the relationship between socio-economic factors – particularly participant educational level and familial social status – and test performance, suggesting that test familiarity develops over time through the mechanism of exposure to ability testing in other contexts. These findings represent a substantial contribution to the field’s understanding of two key issues surrounding ethnic test performance differences. The author calls for a new line of research into these performance facilitating and debilitating factors, before recommendations are offered for practitioners to ensure fairer deployment of ability testing in high-stakes selection processes.

The effect of nutrition education on the nutrition knowledge of college athletes

The relationship between nutrition and athletic performance has become a topic of increasing interest in college athletics. This study assessed the effect of nutrition education on the nutrition knowledge and dietary adequacy of female and male college athletes through a pre-test/post-test, control group design. Six weekly lessons were offered to the experimental groups. For female athletes, a two sample t-test indicated significant differences on gain scores for the experimental group (p

Análise imunoistoquímica após terapia fotodinâmica com cloro-alumínio ftalocianina em tecidos gengivais de humanos

Although photodynamic therapy have been used as a useful tool over the past 30 years in oncology, few clinical trials have been conducted in dentistry. Photodynamic therapy (PDT) uses non - toxic photosensitizers and selective which are administered in target cells followed by local application of visible light, producing reactive oxygen species capable of causing cell death by apoptosis or necrosis, injured the local vasculature, and exert important effects on the im mune system. New generations of photosensitizing agents, such as nanoparticulate phthalocyanines, has shown excellent results in antitumor and antibacterial activity . In this context, the present work constitutes the first clinical protocol of local appli cation of nanoemulsion chloro - aluminum phthalocyanine (AlClFc) followed by irradiation in human gingiva, and analyzed descriptively and comparatively , by means of immunohistochemistry , the expression of RANK , RANKL , OPG and VEGF in a split - mouth model . Eight healthy volunteers with clinical indication for extraction were included in the study . Seven days before the extraction, was injected in the gingiva of participants, 5 μ M of nanoemulsion AlClFc followed by irra diation with diode laser (660nm , 7 J/cm2 ), the contralateral side was used as control. Tissue specimens were removed seven days after the TFD is performed. Tissues sample were divided into two groups (test and con trol groups) for histological and immunohistochemical analysis. Patients were monitored at days, 0, 7, 14 and 30 to assess adverse effects of the therapy. Vascular alterations were seen in gingival samples that received PDT. Areas of edema and vascular con gestion, and intense vascularization were viewed . Additionally, dystrophic calcification in subepithelial region were observed in the test group. The results showed a similar pattern of immunostaining scores of RANK, RANKL and VEGF between the test and co ntrol groups, with no statistically significant difference (p = 0.317, p = 0.777, p = 0 .814, respectively). RANK and RANKL exhibited weak or absent immunostaining in most specimens analyzed. There was n o immunostaining for OPG. VEGF showed moderate to stro ng immunostaining in specimens from the test group. In addition, the clinical study showed that therapy was well tolerated by all patients. Adverse effects were short - time and completely reversible. Taken together, the results presented in this study showe d that PDT mediated by nanoemulsion containing AlClPc is safe for clinical application in gingival tissue and suggests that a strong immunostaining for VEGF after therapy .

Radiotherapy Assessment Using Diffusion Weighted MRI

Purpose: There are two goals of this study. The first goal of this study is to investigate the feasibility of using classic textural feature extraction in radiotherapy response assessment among a unique cohort of early stage breast cancer patients who received the single-dose preoperative radiotherapy. The second goal of this study is to investigate the clinical feasibility of using classic texture features as potential biomarkers which are supplementary to regional apparent diffusion coefficient in gynecological cancer radiotherapy response assessment.

Methods and Materials: For the breast cancer study, 15 patients with early stage breast cancer were enrolled in this retrospective study. Each patient received a single-fraction radiation treatment, and DWI and DCE-MRI scans were conducted before and after the radiotherapy. DWI scans were acquired using a spin-echo EPI sequence with diffusion weighting factors of b = 0 and b = 500 mm2/s, and the apparent diffusion coefficient (ADC) maps were calculated. DCE-MRI scans were acquired using a T1-weighted 3D SPGR sequence with a temporal resolution of about 1 minute. The contrast agent (CA) was intravenously injected with a 0.1 mmol/kg bodyweight dose at 2 ml/s. Two parameters, volume transfer constant (Ktrans) and kep were analyzed using the two-compartment Tofts pharmacokinetic model. For pharmacokinetic parametric maps and ADC maps, 33 textural features were generated from the clinical target volume (CTV) in a 3D fashion using the classic gray level co-occurrence matrix (GLCOM) and gray level run length matrix (GLRLM). Wilcoxon signed-rank test was used to determine the significance of each texture feature’s change after the radiotherapy. The significance was set to 0.05 with Bonferroni correction.

For the gynecological cancer study, 12 female patients with gynecologic cancer treated with fractionated external beam radiotherapy (EBRT) combined with high dose rate (HDR) intracavitary brachytherapy were studied. Each patient first received EBRT treatment followed by five fractions of HDR treatment. Before EBRT and before each fraction of brachytherapy, Diffusion Weighted MRI (DWI-MRI) and CT scans were acquired. DWI scans were acquired in sagittal plane utilizing a spin-echo echo-planar imaging sequence with weighting factors of b = 500 s/mm2 and b = 1000 s/mm2, one set of images of b = 0 s/mm2 were also acquired. ADC maps were calculated using linear least-square fitting method. Distributed diffusion coefficient (DDC) maps and stretching parameter α were calculated. For ADC and DDC maps, 33 classic texture features were generated utilizing the classic gray level run length matrix (GLRLM) and gray level co-occurrence matrix (GLCOM) from high-risk clinical target volume (HR-CTV). Wilcoxon signed-rank statistics test was applied to determine the significance of each feature’s numerical value change after radiotherapy. Significance level was set to 0.05 with multi-comparison correction if applicable.

Results: For the breast cancer study, regarding ADC maps calculated from DWI-MRI, 24 out of 33 CTV features changed significantly after the radiotherapy. For DCE-MRI pharmacokinetic parameters, all 33 CTV features of Ktrans and 33 features of kep changed significantly.

For the gynecological cancer study, regarding ADC maps, 28 out of 33 HR-CTV texture features showed significant changes after the EBRT treatment. 28 out of 33 HR-CTV texture features indicated significant changes after HDR treatments. The texture features that indicated significant changes after HDR treatments are the same as those after EBRT treatment. 28 out of 33 HR-CTV texture features showed significant changes after whole radiotherapy treatment process. The texture features that indicated significant changes for the whole treatment process are the same as those after HDR treatments.

Conclusion: Initial results indicate that certain classic texture features are sensitive to radiation-induced changes. Classic texture features with significant numerical changes can be used in monitoring radiotherapy effect. This might suggest that certain texture features might be used as biomarkers which are supplementary to ADC and DDC for assessment of radiotherapy response in breast cancer and gynecological cancer.

Beam Angle Optimization for Automated Coplanar IMRT Lung Plans

Purpose: To investigate the effect of incorporating a beam spreading parameter in a beam angle optimization algorithm and to evaluate its efficacy for creating coplanar IMRT lung plans in conjunction with machine learning generated dose objectives.

Methods: Fifteen anonymized patient cases were each re-planned with ten values over the range of the beam spreading parameter, k, and analyzed with a Wilcoxon signed-rank test to determine whether any particular value resulted in significant improvement over the initially treated plan created by a trained dosimetrist. Dose constraints were generated by a machine learning algorithm and kept constant for each case across all k values. Parameters investigated for potential improvement included mean lung dose, V20 lung, V40 heart, 80% conformity index, and 90% conformity index.

Results: With a confidence level of 5%, treatment plans created with this method resulted in significantly better conformity indices. Dose coverage to the PTV was improved by an average of 12% over the initial plans. At the same time, these treatment plans showed no significant difference in mean lung dose, V20 lung, or V40 heart when compared to the initial plans; however, it should be noted that these results could be influenced by the small sample size of patient cases.

Conclusions: The beam angle optimization algorithm, with the inclusion of the beam spreading parameter k, increases the dose conformity of the automatically generated treatment plans over that of the initial plans without adversely affecting the dose to organs at risk. This parameter can be varied according to physician preference in order to control the tradeoff between dose conformity and OAR sparing without compromising the integrity of the plan.

Mineralogy of sediments at DSDP Leg 67 Hole

Seven sites were drilled during Leg 67 along a transect across the Middle America Trench off Guatemala: four (Sites 494, 496, 497, and 498) on continental slope, two (Sites 499 and 500) on Trench floor, and one (Site 495) on the Cocos Plate. We studied the mineralogy of sediments from Sites 494, 495, 496, 499, and 500. Our objective was to investigate the origin and source of separate minerals and mineral assemblages, giving special attention to the influence of the alteration of basalts on the sediment mineralogy, which we expected to be particularly important in layers just above oceanic basement.

Pharmacokinetic Profile of Liposome-Encapsulated Ropivacaine after Maxillary Infiltration Anaesthesia

The aim of this study was to determine the pharmacokinetic parameters of liposomal ropivacaine after dental anesthesia in 14 healthy volunteers. In this randomized, double-blind and crossover study, the volunteers received maxillary infiltration of liposome-encapsulated 0.5% ropivacaine and, 0.5% ropivacaine with 1:200,000 epinephrine in two different sessions. Blood samples were collected before and after (from 15 to 1440 min) the administration of either ropivacaine formulation. HPLC with UV detection was used to quantify plasma ropivacaine concentrations. The pharmacokinetic parameters AUC(0-24) (area under the plasma concentration x time curve from baseline to 24 h), AUC(0-infinity) (area under the plasma concentration-time curve from baseline to infinity), C-max (maximum drug concentration), CL (renal clearance), T-max (maximum drug concentration time), t(1/2) (elimination half-life) and Vd (volume of distribution) were analyzed using the Wilcoxon signed-rank test. No differences (p > 0.05) were observed between both formulations for any of the pharmacokinetic parameters evaluated and plasma ropivacaine concentrations, considering each period of time. Both formulations showed similar pharmacokinetic profiles, indicating that the liposomal formulation could be a safer option for use of this local anesthetic, due to the absence of a vasoconstrictor.

Engagement and labour stress in nursing

Engagement is a useful concept in the profession of nursing as it focuses on the positive dimension of human behaviour and visualizes the work context as a positive situation. Evaluate the stress and engagement levels on Portuguese and Spanish nurses and analyse the factors related to the stress and engagement levels in the two sample groups. Comparative exploratory study in a quantitative paradigm. Sample of 867 nurses (504 Portuguese, 363 Spanish), female 83.6% (78.6% Portugal, 90.6% Spain) and average age of 37. Portuguese (77.2%) and Spanish nurses (39.4%), work on average 40 hours per week. 60.6% and 57.7% of the Spanish and Portuguese respectively exercise their profession for 10 years. Sociodemographic questionnaire, the Pamela Gray-Toft’s Nursing Stress Scale (1981) and Schaufeli & Bakker’s Utrecht Work Engagement Scale (2003) were used. In what concerns Engagement there are statistically signiicant differences in the three dimensions, the p-value of the t-Student test were under 5%, highlighting the Spanish nurses for being more vigorous, dedicated and absorbed by their work: vigour, dedication and absorption. The sample of Portuguese nurses experience higher stress levels although the difference with Spanish nurses isn’t statistically signiicant. There are statistically signiicant differences between Portugal and Spain in “Lack of help from colleagues” and also in the psychological domain in general. The Spanish nurses feel more vigorous, dedicated and absorbed by their work. The Portuguese nurses perceive more psychological stress and mention having less help from colleagues.