Extensão do modelo hipercubo para análise de sistemas de atendimento médico emergencial com prioridade na fila

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Conflict affected peoples’ access to education: IDP pupils in Georgia

This work seeks to understand what kind of impact educational policies have had on the secondary school students among internally displaced persons (IDPs) and their identity reconstruction in Georgia. The study offers a snapshot of the current situation based on desk study and interviews conducted among a sample of secondary school IDP pupils. In the final chapter, the findings will be reflected against the broader political context in Georgia and beyond. The study is interdisciplinary and its methodology is based on social identity theory. I shall compare two groups of IDPs who were displaced as a result of two separate conflicts. The IDPs displaced as a result of conflict in Abkhazia in 1992–1994 are named as old caseload IDPs. The second group of IDPs were displaced after a conflict in South Ossetia in 2008. Additionally, I shall touch upon the situation of the pupils among the returnees, a group of Georgian old caseload IDPs, who have spontaneously returned to de facto Abkhazia. According to the interviews, the secondary school student IDPs identify themselves strongly with the Georgian state, but their group identities are less prevailing. Particularly the old case load IDP students are fully integrated in local communities. Moreover, there seems not to be any tangible bond between the old and new caseload IDP students. The schools have neither tried nor managed to preserve IDP identities which would, for instance, make political mobilisation likely along these lines. Right to education is a human right enshrined in a number of international conventions to which the IDPs are also entitled. Access to education or its denial has a deep impact on individual and societal development. Furthermore, education has a major role in (re)constructing personal as well as national identity.

Synthesis of oligosaccharides corresponding to the polysaccharides of Lactobacillus and Thermophlilus strains

Synthesis of a branched trisaccharide and a tetrasaccharide repeating units corresponding to the polysaccharides of Lactobacillus spp. G-77 and Thermus thermophilus Samu-SA1 as their methyl glycosides has been achieved in excellent yield. Most of the glycosyl linkages are 1,2-cis in these oligosaccharide fragments

Cytomegalovirus infection and disease reduce 10-year cardiac allograft vasculopathy-free survival in heart transplant recipients.

BACKGROUND Cytomegalovirus (CMV) is associated with an increased risk of cardiac allograft vasculopathy (CAV), the major limiting factor for long-term survival after heart transplantation (HTx). The purpose of this study was to evaluate the impact of CMV infection during long-term follow-up after HTx. METHODS A retrospective, single-centre study analyzed 226 HTx recipients (mean age 45 ± 13 years, 78 % men) who underwent transplantation between January 1988 and December 2000. The incidence and risk factors for CMV infection during the first year after transplantation were studied. Risk factors for CAV were included in an analyses of CAV-free survival within 10 years post-transplant. The effect of CMV infection on the grade of CAV was analyzed. RESULTS Survival to 10 years post-transplant was higher in patients with no CMV infection (69 %) compared with patients with CMV disease (55 %; p = 0.018) or asymptomatic CMV infection (54 %; p = 0.053). CAV-free survival time was higher in patients with no CMV infection (6.7 years; 95 % CI, 6.0-7.4) compared with CMV disease (4.2 years; CI, 3.2-5.2; p < 0.001) or asymptomatic CMV infection (5.4 years; CI, 4.3-6.4; p = 0.013). In univariate analysis, recipient age, donor age, coronary artery disease (CAD), asymptomatic CMV infection and CMV disease were significantly associated with CAV-free survival. In multivariate regression analysis, CMV disease, asymptomatic CMV infection, CAD and donor age remained independent predictors of CAV-free survival at 10 years post-transplant. CONCLUSIONS CAV-free survival was significantly reduced in patients with CMV disease and asymptomatic CMV infection compared to patients without CMV infection. These findings highlight the importance of close monitoring of CMV viral load and appropriate therapeutic strategies for preventing asymptomatic CMV infection.

Ein Reichstagsabgeordneter als Zionistenführer

Samu Weil

Epigenetic phenotypes distinguish microsatellite-stable and -unstable colorectal cancers

Aberrant DNA methylation is a common phenomenon in human cancer, but its patterns, causes, and consequences are poorly defined. Promoter methylation of the DNA mismatch repair gene MutL homologue (MLH1) has been implicated in the subset of colorectal cancers that shows microsatellite instability (MSI). The present analysis of four MspI/HpaII sites at the MLH1 promoter region in a series of 89 sporadic colorectal cancers revealed two main methylation patterns that closely correlated with the MSI status of the tumors. These sites were hypermethylated in tumor tissue relative to normal mucosa in most MSI(+) cases (31/51, 61%). By contrast, in the majority of MSI(−) cases (20/38, 53%) the same sites showed methylation in normal mucosa and hypomethylation in tumor tissue. Hypermethylation displayed a direct correlation with increasing age and proximal location in the bowel and was accompanied by immunohistochemically documented loss of MLH1 protein both in tumors and in normal tissue. Similar patterns of methylation were observed in the promoter region of the calcitonin gene that does not have a known functional role in tumorigenesis. We propose a model of carcinogenesis where different epigenetic phenotypes distinguish the colonic mucosa in individuals who develop MSI(+) and MSI(−) tumors. These phenotypes may underlie the different developmental pathways that are known to occur in these tumors.

Tolerance of human MSH2+/− lymphoblastoid cells to the methylating agent temozolomide

Members of hereditary nonpolyposis colon cancer (HNPCC) families harboring heterozygous germline mutations in the DNA mismatch repair genes hMSH2 or hMLH1 present with tumors generally two to three decades earlier than individuals with nonfamilial sporadic colon cancer. We searched for phenotypic features that might predispose heterozygous cells from HNPCC kindreds to malignant transformation. hMSH2+/− lymphoblastoid cell lines were found to be on average about 4-fold more tolerant than wild-type cells to killing by the methylating agent temozolomide, a phenotype that is invariably linked with impairment of the mismatch repair system. This finding was associated with an average 2-fold decrease of the steady-state level of hMSH2 protein in hMSH2+/− cell lines. In contrast, hMLH1+/− heterozygous cells were indistinguishable from normal controls in these assays. Thus, despite the fact that HNPCC families harboring mutations in hMSH2 or hMLH1 cannot be distinguished clinically, the early stages of the carcinogenic process in hMSH2 and hMLH1 mutation carriers may be different. Should hMSH2+/− colonocytes and lymphoblasts harbor a similar phenotype, the increased tolerance of the former to DNA-damaging agents present in the human colon may play a key role in the initiation of the carcinogenic process.

Rikskansleren Axel Oxenstiernas skrifter och brefvexling.

Editor of Förra afd. Bd. 1-2, Sen. afd. Bd. 4-5: C. G. Styffe; Förra afd. Bd. 3: Sam Clason; Förra afd. Bd. 4-10: Herman Brulin; Förra afd. Bd. 11.1: Emil Schieche; Förra afd. Bd. 13-15: Tor Berg; Sen. afd. Bd. 1, 3, 6-10: Per Sondén; Sen. afd. Bd. 2: J. F. Nyström; Sen. afd. Bd. 11: Nils Edén; Sen afd. Bd. 12: Nils ahnlund.

Ellen Key, her life and her work,

Mode of access: Internet.

Fast reconstruction of harmonic functions from Cauchy data using the Dirichlet-to-Neumann map and integral equations

We propose and investigate a method for the stable determination of a harmonic function from knowledge of its value and its normal derivative on a part of the boundary of the (bounded) solution domain (Cauchy problem). We reformulate the Cauchy problem as an operator equation on the boundary using the Dirichlet-to-Neumann map. To discretize the obtained operator, we modify and employ a method denoted as Classic II given in [J. Helsing, Faster convergence and higher accuracy for the Dirichlet–Neumann map, J. Comput. Phys. 228 (2009), pp. 2578–2576, Section 3], which is based on Fredholm integral equations and Nyström discretization schemes. Then, for stability reasons, to solve the discretized integral equation we use the method of smoothing projection introduced in [J. Helsing and B.T. Johansson, Fast reconstruction of harmonic functions from Cauchy data using integral equation techniques, Inverse Probl. Sci. Eng. 18 (2010), pp. 381–399, Section 7], which makes it possible to solve the discretized operator equation in a stable way with minor computational cost and high accuracy. With this approach, for sufficiently smooth Cauchy data, the normal derivative can also be accurately computed on the part of the boundary where no data is initially given.

Fast reconstruction of harmonic functions from Cauchy data using integral equation techniques

We consider the problem of stable determination of a harmonic function from knowledge of the solution and its normal derivative on a part of the boundary of the (bounded) solution domain. The alternating method is a procedure to generate an approximation to the harmonic function from such Cauchy data and we investigate a numerical implementation of this procedure based on Fredholm integral equations and Nyström discretization schemes, which makes it possible to perform a large number of iterations (millions) with minor computational cost (seconds) and high accuracy. Moreover, the original problem is rewritten as a fixed point equation on the boundary, and various other direct regularization techniques are discussed to solve that equation. We also discuss how knowledge of the smoothness of the data can be used to further improve the accuracy. Numerical examples are presented showing that accurate approximations of both the solution and its normal derivative can be obtained with much less computational time than in previous works.

Numerical solution of parabolic Cauchy problems in planar corner domains

An iterative method for the parabolic Cauchy problem in planar domains having a finite number of corners is implemented based on boundary integral equations. At each iteration, mixed well-posed problems are solved for the same parabolic operator. The presence of corner points renders singularities of the solutions to these mixed problems, and this is handled with the use of weight functions together with, in the numerical implementation, mesh grading near the corners. The mixed problems are reformulated in terms of boundary integrals obtained via discretization of the time-derivative to obtain an elliptic system of partial differential equations. To numerically solve these integral equations a Nyström method with super-algebraic convergence order is employed. Numerical results are presented showing the feasibility of the proposed approach. © 2014 IMACS.

Vitás kreativitás – szakirodalmi áttekintés a kreativitás fogalmáról

A kreativitás fogalmát gyakran emlegetik a gazdasággal és a versenyképességgel összefüggésben. Ahhoz, hogy ezt a fogalmat kutatásaink során vizsgálni és lehetőség szerint mérni is tudjuk, elengedhetetlen, hogy megfelelően definiáljuk. Mi a tudományelméletben elfogadott, de nem szokványos módon fogunk hozzá a definiáláshoz, ugyanis első körben úgy határoljuk le a fogalmat, hogy számba vesszük, mit nem tartunk kreativitásnak. A közgazdászok számára legnagyobb kihívás egy, a gazdaság szempontjából is megfelelő kreativitás definíció megtalálása. Ugyanis jól látszik, – s tanulmányunkkal is ezt igyekszünk majd bizonyítani – hogy ahány szerző eddig foglalkozott a kreativitással, annyiféle definíció született rá (Nyström, 1983; idézi Iványi – Hoffer, 1999). ____ The concept of creativity is frequently mentioned together with the economy and competitiveness. In order to be able to examine and measure this notion during our research it is crucial to define it clearly. We set about the definition in a way that is accepted in scientific theory, but not usual, namely, first we border the notion by reviewing what we do not consider creativity. The greatest challenge for the economists is to find the definition that is appropriate from an economic viewpoint. It is apparent – and we will endeavor to prove this in our study – that there are as many definitions to creativity as authors who have dealt with it so far (Nyström, 1983, Iványi – Hoffer, 1999).

Avaliação da qualidade da assistência prestada pelo serviço de atendimento móvel de urgência do Rio Grande do Norte

O objetivo dessa investigação foi avaliar a qualidade da assistência prestada pelo Serviço de Atendimento Móvel de Urgência do estado do Rio Grande do Norte (SAMU 192 RN), na visão dos profissionais de saúde. Trata-se de estudo descritivo, avaliativo com delineamento longitudinal e abordagem quantitativa, desenvolvido em quatro etapas: construção de perfil dos atendimentos do SAMU 192 RN; revisão integrativa para levantamento dos indicadores de avaliação da qualidade da assistência em serviços pré-hospitalares móveis de urgência; construção e validação de conteúdo do instrumento e definição dos indicadores de estrutura e processo; e aplicação do instrumento aos profissionais de saúde para avaliação da qualidade da assistência. A populaçãoe amostra foram compostas por todos os profissionais do SAMU 192 RN, atuantes no período do estudo. A coleta de dados foi realizada entre janeiro e dezembro/2012. Participaram do estudo: 11 enfermeiros, 24 médicos, 56 técnicos de enfermagem e 88 condutores, totalizando 179 profissionais. O estudo foi aprovado (Parecer nº 437/2010 e CAAE: 0025.0.294.051-10) pelo Comitê de Ética em Pesquisa do Hospital Universitário Onofre Lopes da Universidade Federal do Rio Grande do Norte. Os dados foram analisados por meio de estatística descritiva e inferencial, nesta foram utilizados os programas Microsoft-Excel XP e SPSS 20.0, com uso do índice Kappa (K) e Índice de Validade de Conteúdo (IVC), considerando K ≥0,61 e IVC>0,80. Além disso, foi considerando nível de significância estatística de ρ-valor < 0,05. Entre os 179 profissionais, 100,0% tinham menos de 5 anos de tempo de serviço, 55,9% tinham menos de 5 anos de experiência na área de urgência, 88,3% referiram trabalhar na instituição porque gosta, 55,3% possuiam outro vínculo de trabalho, 54,3% com jornada semanal de 30 a 40 horas, 98,9% participaram de treinamento, 83,2% valorizam o treinamento em serviço, 87,2% têm boa frequência de participação no treinamento e 96,6% sentem necessidade de realizar mais treinamentos. Com relação à categorização dos itens em indicadores de estrutura ou de processo, os juízes determinaram para estrutura: estado de conservação das ambulâncias; estrutura física geral do serviço; conforto dentro da ambulância; disponibilidade de recursos materiais; segurança para o usuário dentro da ambulância; segurança para o profissional; educação permanente; segurança demonstrada pela equipe profissional; remuneração do profissional e a satisfação profissional. E para processo: acesso ao serviço; acolhimento; humanização; atendimento realizado; tempo resposta; privacidade ao usuário; orientações sobre o atendimento; relacionamento entre o profissional e usuário; oportunidade do usuário realizar reclamações e articulação multiprofissional. O instrumento quando submetido à validação de conteúdo constatou-se que as contribuições dos juízes permitiram melhorar/otimizar o instrumento de avaliação da qualidade da assistência pré-hospitalar móvel de urgência, uma vez que os índices Kappa e IVC foram considerados bons e ótimos e o conteúdo foi validado. Na avaliação da qualidade da assistência, constatou-se que a qualidade da assistência prestada pelo SAMU 192 RN está prejudicada nas dimensões estrutura, com relação à estrutura física, segurança dos pontos de apoio descentralizados, o conforto e o estado de conservação das ambulâncias. Já com relação aos indicadores de processo, os profissionais avaliaram todos positivamente. A avaliação da qualidade da assistência contribui para a busca de soluções dos problemas detectados, permite novas perspectivas e colabora para a consolidação do serviço.