Roger D. Clemence

Original image (attached to acidic board) was photographed and negative created by Lance Burghardt. Photographer of original print unknown

Applying The Maternal Near Miss Approach For The Evaluation Of Quality Of Obstetric Care: A Worked Example From A Multicenter Surveillance Study.

To assess quality of care of women with severe maternal morbidity and to identify associated factors. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

Electrostatic turbulence driven by high magnetohydrodynamic activity in Tokamak Chauffage Alfven Bresilien

In Tokamak Chauffage Alfven Bresilien [R. M. O. Galvao , Plasma Phys. Controlled Fusion 43, 1181 (2001)], high magnetohydrodynamic (MHD) activity may appear spontaneously or during discharges with a voltage biased electrode inserted at the plasma edge. The turbulent electrostatic fluctuations, measured by Langmuir probes, are modulated by Mirnov oscillations presenting a dominant peak with a common frequency around 10 kHz. We report the occurrence of phase locking of the turbulent potential fluctuations driven by MHD activity at this frequency. Using wavelet cross-spectral analysis, we characterized the phase and frequency synchronization in the plasma edge region. We introduced an order parameter to characterize the radial dependence of the phase-locking intensity. (c) 2008 American Institute of Physics.

Thermomechanical processing for recovery of desired < 001 > fiber texture in electric motor steels

A processing route has been developed for recovering the desired lambda fiber in iron-silicon electrical steel needed for superior magnetic properties in electric motor application. The lambda fiber texture is available in directionally solidified iron-silicon steel with the < 001 > columnar grains but was lost after heavy rolling and recrystallization required for motor laminations. Two steps of light rolling each followed by recrystallization were found to largely restore the desired fiber texture. This strengthening of the < 001 > fiber texture had been predicted on the basis of the strain-induced boundary migration (SIBM) mechanism during recrystallization of lightly rolled steel from existing grains of near the ideal orientation, due to postulated low stored energies. Taylor and finite element models supported the idea of the low stored energy of the lambda fiber grains. The models also showed that the lambda fiber grains, though unstable during rolling, only rotated away from their initial orientations quite slowly.

Revision of the chewing louse genus Eutrichophilus (Phthiraptera: Trichodectidae) from the New World porcupines (Rodentia: Erethizontidae)

n.s. no.76(1994)

Molecular epidemiology reveals long-term changes in HIV type 1 subtype B transmission in Switzerland.

BACKGROUND: Sequence data from resistance testing offer unique opportunities to characterize the structure of human immunodeficiency virus (HIV) infection epidemics. METHODS: We analyzed a representative set of HIV type 1 (HIV-1) subtype B pol sequences from 5700 patients enrolled in the Swiss HIV Cohort Study. We pooled these sequences with the same number of sequences from foreign epidemics, inferred a phylogeny, and identified Swiss transmission clusters as clades having a minimal size of 10 and containing >or=80% Swiss sequences. RESULTS: More than one-half of Swiss patients were included within 60 transmission clusters. Most transmission clusters were significantly dominated by specific transmission routes, which were used to identify the following patient groups: men having sex with men (MSM) (38 transmission clusters; average cluster size, 29 patients) or patients acquiring HIV through heterosexual contact (HETs) and injection drug users (IDUs) (12 transmission clusters; average cluster size, 144 patients). Interestingly, there were no transmission clusters dominated by sequences from HETs only. Although 44% of all HETs who were infected between 1983 and 1986 clustered with injection drug users, this percentage decreased to 18% for 2003-2006 (P<.001), indicating a diminishing role of injection drug users in transmission among HETs over time. CONCLUSIONS: Our analysis suggests (1) the absence of a self-sustaining epidemic of HIV-1 subtype B in HETs in Switzerland and (2) a temporally decreasing clustering of HIV infections in HETs and IDUs.

Combinations of prognostic tools for identification of high-risk normotensive patients with acute symptomatic pulmonary embolism.

Background: In haemodynamically stable patients with acute symptomatic pulmonary embolism (PE), studies have not evaluated the usefulness of combining the measurement of cardiac troponin, transthoracic echocardiogram (TTE), and lower extremity complete compression ultrasound (CCUS) testing for predicting the risk of PE-related death. Methods: The study assessed the ability of three diagnostic tests (cardiac troponin I (cTnI), echocardiogram, and CCUS) to prognosticate the primary outcome of PE-related mortality during 30 days of follow-up after a diagnosis of PE by objective testing. Results: Of 591 normotensive patients diagnosed with PE, the primary outcome occurred in 37 patients (6.3%; 95% CI 4.3% to 8.2%). Patients with right ventricular dysfunction (RVD) by TTE and concomitant deep vein thrombosis (DVT) by CCUS had a PE-related mortality of 19.6%, compared with 17.1% of patients with elevated cTnI and concomitant DVT and 15.2% of patients with elevated cTnI and RVD. The use of any two-test strategy had a higher specificity and positive predictive value compared with the use of any test by itself. A combined three-test strategy did not further improve prognostication. For a subgroup analysis of high-risk patients, according to the pulmonary embolism severity index (classes IV and V), positive predictive values of the two-test strategies for PE-related mortality were 25.0%, 24.4% and 20.7%, respectively. Conclusions: In haemodynamically stable patients with acute symptomatic PE, a combination of echocardiography (or troponin testing) and CCUS improved prognostication compared with the use of any test by itself for the identification of those at high risk of PE-related death.

Alquería. S.A. "una historia de larga vida que empieza aqui"

El trabajo investigativo que se presenta a continuación, es un estudio realizado con el apoyo de la Facultad de Administración de la Universidad del Rosario, donde se analiza la empresa Alquería, como aquella empresa ejemplar galardonada con el premio Ave Fénix, que a finales de los años 90 vivió una crisis financiera, y cuatro (4) años después, gracias a su compromiso, dedicación y esfuerzo salió avante y hoy es una empresa exitosa en el sector lechero Colombiano. años 90, Colombia se encontraba en un proceso de apertura económica donde el presidente de ese entonces Cesar Gaviria, propuso integrar la economía nacional a los mercados globales. El objetivo de esta medida era ofrecer nuevas oportunidades de mercado para la industria nacional, con lo que se esperaba incrementar la competitividad y desarrollo de las empresas Colombianas. La medida provocó que la economía entrara en crisis, obligando al Gobierno a expedir la Ley 550 de 1999, con la que se buscaba dotar a Colombia de instrumentos adecuados para proteger aquellas empresas viables que se encontraban en crisis y salvarlas de la muerte empresarial. Alquería se acoge a la Ley con una deuda de 30 mil millones de pesos según el diario El Espectador en su publicación del 22 de marzo del 2009, iniciando así un proceso de restructuración con el seguimiento y apoyo de la Superintendencia de Sociedades. El proceso que duró 4 años, tuvo como objetivo renegociar las tasas de interés, redefinir los plazos de pago de las acreencias con los bancos, dar mayor eficiencia en el manejo de los recursos y asesoría administrativa por parte de nuevos consultores. La investigación está compuesta de 3 capítulos, los cuales mostraran un antes, un durante y un después de la crisis, en los que se va a analizar el proceso que vivió la empresa tomando en cuenta las estrategias, cambios, decisiones y reformas que se hicieron al interior. En el primer capítulo se plantea EL PROBLEMA a investigar, registrando aspectos como antecedentes y marco legal; El segundo capítulo está dedicado a la DIRECCIÓN, en el que se analizará el liderazgo, la estrategia y la realidad empresarial de Alquería, y como tercero y último capítulo, se va a estudiar la GERENCIA, analizando desde el enfoque de mercadeo, finanzas, gestión humana, producción y perdurabilidad.

Climate change adaptation strategies in Sub-Saharan Africa: foundations for the future

Many institutions across sub-Saharan Africa (SSA) and many funding agencies that support them are currently engaged in initiatives that are targeted towards adapting rainfed agriculture to climate change. This does, however, present some very real and complex research and policy challenges. Given to date the generally low impact of agricultural research across SSA on improving the welfare of rainfed farmers under current climatic conditions, a comprehensive strategy is required if the considerably more complex challenge of adapting agriculture to future climate change is to bear fruit. In articulating such a strategy, it is useful to consider the criteria by which current successful initiatives should be judged.

FTO influences adipogenesis by regulating mitotic clonal expansion

The fat mass and obesity-associated (FTO) gene plays a pivotal role in regulating body weight and fat mass; however, the underlying mechanisms are poorly understood. Here we show that primary adipocytes and mouse embryonic fibroblasts (MEFs) derived from FTO overexpression (FTO-4) mice exhibit increased potential for adipogenic differentiation, while MEFs derived from FTO knockout (FTO-KO) mice show reduced adipogenesis. As predicted from these findings, fat pads from FTO-4 mice fed a high-fat diet show more numerous adipocytes. FTO influences adipogenesis by regulating events early in adipogenesis, during the process of mitotic clonal expansion. The effect of FTO on adipogenesis appears to be mediated via enhanced expression of the pro-adipogenic short isoform of RUNX1T1, which enhanced adipocyte proliferation, and is increased in FTO-4 MEFs and reduced in FTO-KO MEFs. Our findings provide novel mechanistic insight into how upregulation of FTO leads to obesity.

Crystal structure of the triclinic form of (2tbpo·H +)2tetrachlorocuprate(II){[(PhCH2) 3PO]2H}2CuCl4: The presence of extremely short O-H-O interactions

The structure of {[(PhCH2)3PO]2H} 2CuCl4 has been shown to contain four [(PhCH 2)3PO]2H+ cations with extremely short O-H-O distances of 2.295, 2.364, 2.394, and 2.404 Å, respectively.

Synthesis, structure, and electronic and EPR spectra of copper(II) complexes containing the [CuBr4]2- anion and triphenylarsine oxide

The preparation and characterization of (Ph3AsOH)2[CuBr4] and [Cu(Ph3AsO)4][CuBr4] are reported (Ph3AsO = triphenylarsine oxide). Crystallographic analysis of the monoclinic crystals of (Ph3AsOH)2[CuBr4] (space group C2/c, a = 17.569 (3) Å, b = 13.090 (2) Å, c = 16.933 (2) Å, and β = 105.64 (2)°, R = 0.055 and Rw = 0.057) revealed the presence of compressed [CuBr4]2- tetrahedra of C2 symmetry with Cu-Br distances of 2.340 (1) and 2.437 (1) Å and trans-Br-Cu-Br angles of 139.2 (1) and 122.4 (1)°. The oxonium cations hydrogen bond to the bromine atoms involved in the longer Cu-Br bonds and the smaller trans-Br-Cu-Br angle. Single-crystal electronic and EPR spectra are interpreted in terms of the observed [CuBr4]2- geometry. Analysis of the electronic and EPR spectra of [Cu(Ph3AsO)4][CuBr4] led to the postulation of the presence of planar [Cu(Ph3AsO)4]2+ cations and distorted tetrahedral [CuBr4]2- anions. © 1992 American Chemical Society.

Risk stratification of normotensive patients with acute symptomatic pulmonary embolism

Treatment guidelines recommend strong consideration of thrombolysis in patients with acute symptomatic pulmonary embolism (PE) that present with arterial hypotension or shock because of the high risk of death in this setting. For haemodynamically stable patients with PE, the categorization of risk for subgroups may assist with decision-making regarding PE therapy. Clinical models [e.g. Pulmonary Embolism Severity Index (PESI)] may accurately identify those at low risk of overall death in the first 3 months after the diagnosis of PE, and such patients might benefit from an abbreviated hospital stay or outpatient therapy. Though some evidence suggests that a subset of high-risk normotensive patients with PE may have a reasonable risk to benefit ratio for thrombolytic therapy, single markers of right ventricular dysfunction (e.g. echocardiography, spiral computed tomography, or brain natriuretic peptide testing) and myocardial injury (e.g. cardiac troponin T or I testing) have an insufficient positive predictive value for PE-specific mortality to drive decision-making toward such therapy. Recommendations for outpatient treatment or thrombolytic therapy for patients with PE necessitate further development of prognostic models and conduct of clinical trials that assess various treatment strategies.