Unit maintenance repair parts and special tools lists : tractor, full tracked, low speed, heavy drawbar pull, (size T-11), w/angle dozer, winch and rops, Caterpillar model D8K-8A-58 (CCE), NSN 2410-00-574-7597 and w/bulldozer (semi-u-tilt), ripper and rops, Caterpillar model D8K-8S-8 (CCE), NSN 2410-00-574-7598.

Includes indexes.

Finlandismer och språkvård från 1800-talet till i dag

The aim of the study is to investigate the use of finlandisms in an historical perspective, how they have been viewed from the mid-19th century to this day, and the effect of language planning on their use. A finlandism is a word, a phrase, or a structure that is used only in the Swedish varieties used in Finland (i.e. in Finland Swedish), or used in these varieties in a different meaning than in the Swedish used in Sweden. Various aspects of Finland-Swedish language planning are discussed in relation to language planning generally; in addition, the relation of Finland Swedish to Standard Swedish and standard regional varieties is discussed, and various types of finlandisms are analysed in detail. A comprehensive picture is provided of the emergence and evolution of the ideology of language planning from the mid-19th century up until today. A theoretical model of corpus planning is presented and its effect on linguistic praxis described. One result of the study is that the belief among Finland-Swedish language planners that the Swedish language in Finland must not be allowed to become distanced from Standard Swedish, has been widely adopted by the average Finland Swede, particularly during the interwar period, following the publication of Hugo Bergroth s work Finlandssvenska in 1917. Criticism of this language-planning ideology started to appear in the 1950s, and intensified in the 1970s. However, language planning and the basis for this conception of language continue to enjoy strong support among Swedish-speaking Finns. I show that the editing of Finnish literary texts written in Swedish has often been somewhat amateurish and the results not always linguistically appropriate, and that Swedish publishers have in fact adopted a rather liberal attitude towards finlandisms. My conclusion is that language planning has achieved rather modest results in its resistance to finlandisms. Most of the finlandisms used in 1915 were still in use in 2005. Finlandisms occur among speakers of all ages, and even among academically educated people despite their more elevated style. The most common finlandisms were used by informants of all ages. The ones that are firmly rooted are the most established, in other words those that are stylistically neutral, seemingly genuinely Swedish, but which are nevertheless strongly supported by Finnish, and display a shift in meaning as compared with Standard Swedish.

Un modelo de programación por metas para la elaboración del contrato-programa de un hospital público

[ES] Proponemos un modelo de programación por metas para la estimación del plan de producción (case-mix) que debe reflejarse en el Contrato–Programa que suscriben anualmente los Hospitales Públicos y la Administración. Las variables de decisión son los volúmenes de actividad de cada servicio médico del hospital y los atributos son los indicadores básicos que se manejan al elaborar el Contrato-Programa: fi nanciación, número de altas, estancia media y peso de complejidad. Para resolver nuestro modelo empleamos la herramienta SOLVER de la hoja de cálculo EXCEL. La utilización de esta herramienta permite simular varios escenarios de una manera ágil, lo que es de gran ayuda para el estudio y discusión de las cantidades a contratar entre el Hospital y la Administración. El artículo finaliza con una breve presentación de los resultados obtenidos al aplicar nuestro modelo a un hospital de tamaño medio (118 camas) del Servicio Vasco de Salud.

Latent variable models for neural data analysis

The brain is perhaps the most complex system to have ever been subjected to rigorous scientific investigation. The scale is staggering: over 10^11 neurons, each making an average of 10^3 synapses, with computation occurring on scales ranging from a single dendritic spine, to an entire cortical area. Slowly, we are beginning to acquire experimental tools that can gather the massive amounts of data needed to characterize this system. However, to understand and interpret these data will also require substantial strides in inferential and statistical techniques. This dissertation attempts to meet this need, extending and applying the modern tools of latent variable modeling to problems in neural data analysis.

It is divided into two parts. The first begins with an exposition of the general techniques of latent variable modeling. A new, extremely general, optimization algorithm is proposed - called Relaxation Expectation Maximization (REM) - that may be used to learn the optimal parameter values of arbitrary latent variable models. This algorithm appears to alleviate the common problem of convergence to local, sub-optimal, likelihood maxima. REM leads to a natural framework for model size selection; in combination with standard model selection techniques the quality of fits may be further improved, while the appropriate model size is automatically and efficiently determined. Next, a new latent variable model, the mixture of sparse hidden Markov models, is introduced, and approximate inference and learning algorithms are derived for it. This model is applied in the second part of the thesis.

The second part brings the technology of part I to bear on two important problems in experimental neuroscience. The first is known as spike sorting; this is the problem of separating the spikes from different neurons embedded within an extracellular recording. The dissertation offers the first thorough statistical analysis of this problem, which then yields the first powerful probabilistic solution. The second problem addressed is that of characterizing the distribution of spike trains recorded from the same neuron under identical experimental conditions. A latent variable model is proposed. Inference and learning in this model leads to new principled algorithms for smoothing and clustering of spike data.

Caracterização e diversidade molecular do transposon Tn1546, carreador do gene vanA, responsável pela expressão de resistência à vancomicina, em amostras clínicas de diferentes espécies de Enterococcus

Enterococcus resistentes à vancomicina (VRE) são reconhecidos como importantes patógenos causadores de infecções nosocomiais, configurando um grave problema de saúde pública, principalmente pela escassez de opção terapêutica eficaz. O fenótipo de resistência VanA é o mais frequente, sendo definido pela resistência a altos níveis de vancomicina e teicoplanina. VanA é caracterizado por um conjunto gênico (vanRSHAXYZ) localizado no elemento genético móvel denominado transposon Tn1546. A diversidade de Tn1546 resulta de alterações estruturais promovidas por deleções ou integração de sequências de inserção (IS) que, exercem papel chave na evolução do elemento VanA, modificando os aspectos relacionados à sua transferência e expressão do fenótipo. O objetivo deste estudo foi caracterizar e avaliar o polimorfismo de elementos Tn1546 presentes em amostras de diferentes espécies de Enterococcus isoladas em instituições hospitalares do Estado do Rio de Janeiro no período de 2000 a 2012. Foram incluídas neste estudo 70 amostras VRE que foram caracterizadas quanto ao gênero, espécies e genótipo de resistência aos glicopeptídeos por métodos convencionais e PCR multiplex. A susceptibilidade a 17 antimicrobianos foi avaliada pelo método de difusão em ágar, e concentração inibitória mínima (CIM) para vancomicina e teicoplanina foi determinada por microdiluição em caldo. O tranposon foi obtido após lise das células bacterianas e amplificação por PCR longo, utilizando-se oligonucleotídeos específicos para a região repetida e invertida que flanqueia este elemento genético. A diversidade dos elementos Tn1546 foi avaliada por um conjunto de métodos moleculares que incluiu a análise do polimorfismo do tamanho de fragmentos de restrição (restriction fragment lenght polymorphism, RFLP), utilizando-se a endonuclease ClaI, amplificação de segmentos internos por PCR de sobreposição de oligonucleotídeos (overlapping PCR) e detecção de sequências de inserção (ISs). A caracterização em espécies considerada para as demais análises foi obtida pela metodologia de PCR de acordo com a seguinte distribuição: E. avium (N=6), E. faecalis (N=12), E. faecium (N=46), E. gallinarum (N=4) e E. raffinosus (N=2). Todas as amostras apresentaram o genótipo vanA. Nos testes de susceptibilidade aos antimicrobianos foi observado que todas as amostras foram multirresistentes, sendo resistente de 6 a 13 dentre os 17 antimicrobianos testados. A presença de elementos semelhantes ao arquétipo de Tn1546 foi observada em 61,5% das amostras; entretanto, 27 amostras apresentaram perfis variantes de Tn1546. Foram identificados nove perfis de RFLP, dentre 66 avaliadas, sendo o perfil I, prevalente e semelhante ao arquétipo de Tn1546. Não foi possível analisar quatro amostras por RFLP. Os produtos de amplificação de Tn1546 alterados, obtidos pela overlapping PCR e pelo rastreamento de IS, levaram à classificação de 15 tipos polimórficos, nomeados de A a O. A maioria dos Tn1546 polimórficos teve suas regiões de ORF1 e/ou ORF2 deletadas; e IS1542 juntamente com IS1216V foram as inserções mais frequentes, que em muitas situações compartilhavam a mesma região de inserção. IS19 foi detectada apenas na região vanS-vanH. Os dados apresentados neste estudo indicam que o polimorfismo de Tn1546 pode ser explorado no rastreamento de rotas de transmissão, acompanhamento da dispersão de elementos VanA e investigação da evolução de amostras VRE.

Extraction of genomic DNA using a new amino silica monolithic column

A new amino silica monolithic column was developed for DNA extraction in a miniaturized format. The monolithic column was prepared in situ by polymerization of tetraethoxysilane (TEOS) and N-(beta-aminoethyl)-gamma-aminopropylmethyldimethoxysilane (AEAPMDMS). DNA was loaded in 50 mM tris(hydroxylmethyl)aminomethane-EDTA buffer at pH 7.0 and eluted with 300 mM potassium phosphate solution at pH 10.0. Under optimal condition, a 6.0-cm monolithic column provided a capacity of 56 ng DNA with an extraction efficiency of 71 +/- 5.2% (X +/- RSD). When the amino silica monolithic column was applied to extract genomic DNA from the whole blood of crucian carp, an extraction efficiency of 52 +/- 5.6% (X +/- SD) was obtained by three extractions. Since the chaotropic-based sample loading and organic solvent wash steps were avoided in this procedure, the purified DNA was suitable for downstream processes such as PCR. This amino silica monolithic column was demonstrated to allow rapid and efficient DNA purification in microscale.

Synthesis of novel hexagon SnO2 nanosheets in ethanol/water solution by hydrothermal process

The novel hexagon SnO2 nanosheets are successfully synthesized in ethanol/water solution by hydrothermal process. The samples are characterized by X-ray diffraction (XRD), infrared ray (IR) and transmission electron microscopy (TEM). By changing the reaction conditions, the size and the morphology can be controlled. Comparison experiments show that when the temperature increased from 140 degrees C to 180 degrees C, the edge length of the hexagon nanoparticles increases from 300-450 nm to 700-900 nm. On the other hand, by adjusting the ratios of water to ethanol from 2 to 0.5, SnO2 nanoparticles with different morphologies of triangle and sphere are obtained. When the concentration of NaOH is increased from 0.15 M to 0.30 M, a hollow ring structure can be obtained. (c) 2006 Elsevier B.V. All rights reserved.

Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. RESULTS: There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). DISCUSSION: Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.

Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation: dose-response data and safety profile.

BACKGROUND: Adenosine-induced transient flow arrest has been used to facilitate clip ligation of intracranial aneurysms. However, the starting dose that is most likely to produce an adequate duration of profound hypotension remains unclear. We reviewed our experience to determine the dose-response relationship and apparent perioperative safety profile of adenosine in intracranial aneurysm patients. METHODS: This case series describes 24 aneurysm clip ligation procedures performed under an anesthetic consisting of remifentanil, low-dose volatile anesthetic, and propofol in which adenosine was used. The report focuses on the doses administered; duration of systolic blood pressure <60 mm Hg (SBP(<60 mm Hg)); and any cardiovascular, neurologic, or pulmonary complications observed in the perioperative period. RESULTS: A median dose of 0.34 mg/kg ideal body weight (range: 0.29-0.44 mg/kg) resulted in a SBP(<60 mm Hg) for a median of 57 seconds (range: 26-105 seconds). There was a linear relationship between the log-transformed dose of adenosine and the duration of a SBP(<60 mm Hg) (R(2) = 0.38). Two patients developed transient, hemodynamically stable atrial fibrillation, 2 had postoperative troponin levels >0.03 ng/mL without any evidence of cardiac dysfunction, and 3 had postoperative neurologic changes. CONCLUSIONS: For intracranial aneurysms in which temporary occlusion is impractical or difficult, adenosine is capable of providing brief periods of profound systemic hypotension with low perioperative morbidity. On the basis of these data, a dose of 0.3 to 0.4 mg/kg ideal body weight may be the recommended starting dose to achieve approximately 45 seconds of profound systemic hypotension during a remifentanil/low-dose volatile anesthetic with propofol induced burst suppression.

An evaluation of remifentanil-sevoflurane response surface models in patients emerging from anesthesia: model improvement using effect-site sevoflurane concentrations.

INTRODUCTION: We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a return of responsiveness during emergence from anesthesia and a response to tibial pressure when patients required analgesics in the recovery room. We hypothesized that model predictions would be consistent with observed responses. We also hypothesized that under non-steady-state conditions, accounting for the lag time between sevoflurane effect-site concentration (Ce) and end-tidal (ET) concentration would improve predictions. METHODS: Twenty patients received a sevoflurane, remifentanil, and fentanyl anesthetic. Two model predictions of responsiveness were recorded at emergence: an ET-based and a Ce-based prediction. Similarly, 2 predictions of a response to noxious stimuli were recorded when patients first required analgesics in the recovery room. Model predictions were compared with observations with graphical and temporal analyses. RESULTS: While patients were anesthetized, model predictions indicated a high likelihood that patients would be unresponsive (> or = 99%). However, after termination of the anesthetic, models exhibited a wide range of predictions at emergence (1%-97%). Although wide, the Ce-based predictions of responsiveness were better distributed over a percentage ranking of observations than the ET-based predictions. For the ET-based model, 45% of the patients awoke within 2 min of the 50% model predicted probability of unresponsiveness and 65% awoke within 4 min. For the Ce-based model, 45% of the patients awoke within 1 min of the 50% model predicted probability of unresponsiveness and 85% awoke within 3.2 min. Predictions of a response to a painful stimulus in the recovery room were similar for the Ce- and ET-based models. DISCUSSION: Results confirmed, in part, our study hypothesis; accounting for the lag time between Ce and ET sevoflurane concentrations improved model predictions of responsiveness but had no effect on predicting a response to a noxious stimulus in the recovery room. These models may be useful in predicting events of clinical interest but large-scale evaluations with numerous patients are needed to better characterize model performance.

Teaching neuraxial anesthesia techniques for obstetric care in a Ghanaian referral hospital: achievements and obstacles.

Anesthesia providers in low-income countries may infrequently provide regional anesthesia techniques for obstetrics due to insufficient training and supplies, limited manpower, and a lack of perceived need. In 2007, Kybele, Inc. began a 5-year collaboration in Ghana to improve obstetric anesthesia services. A program was designed to teach spinal anesthesia for cesarean delivery and spinal labor analgesia at Ridge Regional Hospital, Accra, the second largest obstetric unit in Ghana. The use of spinal anesthesia for cesarean delivery increased significantly from 6% in 2006 to 89% in 2009. By 2012, >90% of cesarean deliveries were conducted with spinal anesthesia, despite a doubling of the number performed. A trial of spinal labor analgesia was assessed in a small cohort of parturients with minimal complications; however, protocol deviations were observed. Although subsequent efforts to provide spinal analgesia in the labor ward were hampered by anesthesia provider shortages, spinal anesthesia for cesarean delivery proved to be practical and sustainable.