Physician perceptions of risk regarding mood disorders and pharmacological management during pregnancy: What is current practice?

Mood disorders are the most common form of mental illness and one of the leading causes of morbidity worldwide. Major depressive disorder and bipolar disorder have a lifetime prevalence of 16.2% and 4.4%, respectively. Women comprise a substantial proportion of this population, and an estimated 500,000 pregnancies each year involve women with a psychiatric condition. Management with psychotropic medications is considered standard of care for most patients with mood disorders. However, many of these medications are known human teratogens. Because pregnant women with mood disorders face a high risk of relapse if unmanaged, the obstetrician faces a unique challenge in providing the best care to both mother and baby. It has been suggested that many obstetricians overestimate the teratogenic risks associated with psychotropic medications, while concurrently underestimating the risks associated with unmanaged mood disorders. This may be due a knowledge gap regarding the most current teratogen information, and lack of official management guidelines. Therefore, the purpose of this study is to determine the current knowledge base of obstetricians regarding the teratogenic effects of common psychotropic medications, as wells as to capture current management practices for pregnant women with mood disorders. A total of 117 Texas obstetricians responded to a survey regarding teratogen knowledge and management practice. It was common for respondents to encounter women who disclose both having a mood disorder and taking a psychotropic medication during pregnancy. Many respondents did not utilize up-to-date drug counseling resources, and were unaware of or over-estimated the teratogenic risks of common medications used to treat mood disorders. Finally, many respondents reported wanting to refer pregnant patients with mood disorders to psychiatrists for co-management, but are reportedly restricted in doing so due to accessibility or insurance issues. This study demonstrates that there is a knowledge gap among obstetricians regarding the teratogenicity of common psychotropic medications utilized to manage a patient population they frequently encounter. Further, obstetricians have vastly different risk perceptions of these medications, resulting in various management approaches and recommendations. Future research should focus on establishing standard practice guidelines, as well as better accessibility to psychiatric services for pregnant women.

Upgrading of thethird generation of the Remote Diagnostic Systems for ABB Marine Propulsion Systems

Remote diagnostics has become very popular in marine industry. Diagnostic systems are improved all the time and the newest monitoring systems are constantly taken into operation. Most vessels are, however, rigged up by outmoded facilities, which should be updated. In this work the principles of operating of such a remote diagnostic system as the ABB's third generation remote diagnostic system (RDS) and the newest Propulsion Condition Management System (PCMS) are studied. As a result of the thesis the ways of upgrading the old systems of RDS are presented. Specifically, the work focuses on the establishment of the connection between Advant controller AC-110 from the old system and PCMS server, and in other words how to get Modbus data by OPC server.

EFQM-mallin implementointi osaksi johtamisjärjestelmää

Diplomityön tavoitteena oli tutkia kohdeyrityksen EFQM-mallin ja toimintajärjestelmän yhdistämistä niin, että niistä voitaisiin rakentaa yksi yhtenäinen johtamisjärjestelmä. Tarkoituksena oli rakentaa ratkaisumalli, jonka avulla mainitut mallit saataisiin liitettyä osaksi käytännön johtamis- ja kehittämistyövälineitä. Työ on toimintatutkimus, joka rakentuu erillisistä teoria- ja empiriaosioista. Teoriaosassa käsitellään yritystoiminnan perustekijöitä, johtamista tukevia menetelmiä sekä EFQM-mallia. Soveltavassa osuudessa näiden teoreettisten viitekehysten pohjalta rakennetaan ratkaisu alkuperäisen tavoitteen mukaisesti. Onnistuneen järjestelmien yhdistämisen lähtökohtana on, että yrityksen perustekijät ovat kunnossa. Johdon vahva sitoutuminen projektiin on keskeisessä asemassa, jotta syntyvä järjestelmä saadaan palvelemaan yrityksen tavoitteita. Oikein rakennettuna järjestelmä helpottaa päätöksentekoa sekä toimii vahvana tukena strategiselle ja operatiiviselle johtamiselle.

Kompressoriyksiköiden mekaaninen kunnonhallinta

Kunnossapidon kuluista suurimman osan aiheuttavat koneiden ennakoimattomat rikkoutumiset ja niiden tuomat tuotannonpysäytykset. Kunnossapidon suunnitelmallisuutta ja vikojen ennustettavuutta pyritään parantamaan erilaisin kunnonvalvonnallisin keinoin. Havaitsemalla alkava vikaantuminen ajoissa ja seuraamalla sen kehittymistä luodaan mahdollisuus korjaustoimenpiteiden ja -ajankohdan hallittuun suunnitteluun ja tätä kautta kustannussäästöihin. Tässä työssä on tutkittu kompressoriyksiköiden (kaasuturbiini ja keskipakokompressori) ja niiden apulaitteiden kunnossapidon menetelmiä, niiden hyödynnettävyyttä sekä mahdollisuuksia kehittää mekaanista kunnonhallintaa. Työssä päädyttiin johtopäätökseen, että käytettävien menetelmien hyödynnettävyydessä on kehitettävää. Kunnonvalvonnan ohjeistuksia tarkennettiin vastaamaan tämän päivän tavoitteita. Todettiin myös, että värähtelynvalvontaan perustuva kunnonvalvontajärjestelmä soveltuu hyvin kompressoriyksiköiden kunnonvalvonnan järjestelmäksi. Värähtelynvalvontaan perustuva kunnonvalvontajärjestelmä luo mahdollisuuden turvallisen käyttöajan ennustamiseen. Kunnonvalvonnan kehittämisen ja käyttövarmuuden parantamisen kannalta jatkotutkimuksen tekeminen kompressoriyksiköiden mekaanistenlaitteiden turvallisen käyttöajan ennustamiseksi on perusteltua.

Manutenção de sistemas produtivos: um estudo sobre a gestão da disponibilidade de equipamentos.

Este trabalho traduz um estudo de casos, que procura pesquisar e sistematizar o conhecimento sobre a gestão do estado dos equipamentos para atender às suas funções produtivas, isto é, uma gestão orientada para resultados. A função manutenção tem sido considerada como aquela que agrega conhecimentos e atividades para assegurar a disponibilidade operacional dos sistemas produtivos, dentro de padrões de desempenho antecipadamente especificados, ao menor custo possível e atendendo a requisitos pertinentes de segurança. Nesse contexto, pretende-se caracterizar de que modo abordagens ou políticas, adotadas por empresas selecionadas, que requerem o exercício da função manutenção, se vinculam a indicadores de disponibilidade. Ao longo do trabalho, a disponibilidade é tratada como um \"indicador de resultado\" das atividades de manutenção. Transparece da literatura que a análise da tendência desse indicador deve orientar as tomadas de decisão referentes às ações sobre o equipamento. Desse modo, compete verificar se, e como, é feito o vínculo entre esse indicador e decisões relativas à manutenção, sem perder de vista a produtividade da empresa. Assim, descreve-se o contexto em que se inserem a manutenção e a disponibilidade e são identificados elementos que, interferindo na disponibilidade, permitem desdobrá-la e associá-la a uma estrutura analítica que auxilie o levantamento e encaminhamento de análises sobre os dados obtidos no campo, para melhor percepção do tratamento dado à disponibilidade. Para possibilitar o encaminhamento do estudo de casos e a definição das proposições de pesquisa, a função manutenção é associada a um processo, em que se usa o indicador de disponibilidade como feedback, para a otimização do próprio processo de operação da função manutenção, bem como da especificação dos recursos de entrada desse processo. Três proposições são estruturadas e verificadas em quatro empresas que tipificam dois grupos distintos de operações, focalizando o tratamento dado à disponibilidade, e, no seu âmbito, o tratamento de compromissos de gestão e do estudo do ciclo de vida do equipamento. Para possibilitar uma avaliação objetiva das variáveis das proposições da pesquisa, que são de natureza essencialmente qualitativa, encontrou-se, no Capability Maturity Model (CMM), um modelo conceitual que, por suas características evolutivas, forneceu inspiração para estruturar o necessário instrumento de avaliação. A conclusão da pesquisa revela que as proposições de estudo não se confirmaram de forma plena, apontando sensível diferença de seu atendimento quando se faz a comparação entre os dois grupos de empresas, deixando, assim, um espaço em aberto para novas pesquisas.

Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy

The objectives of this study were to ascertain consumer knowledge and behaviour about hypertension and treatment and to compare these with health care providers' perceptions (of 'most' consumers). The design for the study was a problem detection study (PDS): focus groups and then survey. Focus groups and survey participants were convenience samples of consumers, doctors, nurses and pharmacists. The main outcome measures were agreement on a 5-point Likert scale with statements about consumers' knowledge and behaviour about high blood pressure and medication. The survey identified areas of consensus and disagreement between consumers and health providers. While general knowledge and concordance with antihypertensive therapy among consumers was good, consequences such as eye and kidney disease, interactions with herbal medicines, and how to deal with missing a dose were less well known. Side effects were a problem for over one-quarter of participants, and cost was a problem in continuing therapy. Half the consumers had not received sufficient written information. Providers overall disagreed that most consumers have an adequate understanding of the condition. They agreed that most consumers adhere to therapy and can manage medicines; and about their own profession's role in information provision and condition management. Consumers confirmed positive provider behaviour, suggesting opportunities for greater communication between providers about actions taken with their consumers. In conclusion, the PDS methodology was useful in identifying consumer opinions. Differences between consumer and provider responses were marked, with consumers generally rating their knowledge and behaviour above providers' ratings of 'most' consumers. There are clear gaps to be targeted to improve the outcomes of hypertension therapy.

Remote Condition Monitoring and Asset Management in Offshore Power Systems

Condition monitoring systems for physical assets are constantly becoming more and more common in the industrial sector. At the same time an increasing portion of asset monitoring systems are being remotely supported. As global competitors are actively developing solutions for condition monitoring and condition-based maintenance, which it enables, Wärtsilä too feels the pressure to provide customers with more sophisticated condition-based maintenance solutions. The main aim of this thesis study is to consider Wärtsilä remote condition monitoring solutions and how they relate to similar solutions from other suppliers and end customers’ needs, in the context of offshore assets. A theoretical study is also included in the thesis, where the concepts of condition monitoring, condition-based maintenance, maintenance management and physical asset management are introduced.

Evaluation of Condition Scoring of Feeder Calves as a Tool for Management and Nutrition

Two experiments were conducted to evaluate the effects of body condition scores of beef calves on performance efficiency and carcass characteristics. In Experiment 1, 111 steer calves were stratified by breed and condition score (CS) and randomly allotted to 14 pens. The study was analyzed as a 2 x 3 factorial design, with two breeds (Angus and Simmental) and three initial CS (4.4, 5.1, and 5.6). In Experiment 2, 76 steer calves were allotted to six pens by CS. The resultant pens averaged 3.9, 4.5, 4.7, 5.0, 5.1, and 5.6 in CS. Calves in both studies were fed a corn-based finishing diet formulated to 13.5% crude protein. All calves were implanted with Synovex- SÒ initially and reimplanted with Revalor-SÒ. In Experiment 1, 29-day dry matter intake (lb/day) increased with CS (17.9, 18.1, and 19.1 for 4.4, 5.1, and 5.6, respectively; p < .04). Daily gain (29 days) tended to decrease with increasing CS (4.19, 3.71, and 3.26; p < .13). Days on feed decreased with increasing CS (185, 180, and 178d; p < .07). In Experiment 2, daily gains also increased with decreasing initial CS for the first 114 days (p < .05) and tended to increase overall (p < .20). In Experiment 1, calves with lower initial CS had less external fat at slaughter (.48, .53, and .61 in. for CS 4.4, 5.1, and 5.6, respectively; p < .05). This effect was also noted at slaughter (p < .10), as well as at 57 days (p < .06) and at 148 days (p < .06) as measured by real-time ultrasound. Measurements of intramuscular fat and marbling were not different in either study. These data suggest that CS of feeder calves may be a useful tool for adjusting energy requirements of calves based on body condition. Also, feeder cattle may be sorted into outcome or management groups earlier than currently practiced using body condition and/or real-time ultrasound.

The nurse's guide or Short and safer rules for the management of women of each rank and condition in child-bed : : with directions about the choice of a wet-nurse in a dialogue betwixt a surgeon and a nurse.

Mode of access: Internet.

Clinical notes on uterine surgery, with special reference to the management of the sterile condition.

Mode of access: Internet.

Ecology and physical condition of red deer in the Iberian Peninsula: implications for management

The red deer (Cervus elaphus) is currently one of the most widespread and abundant wild ungulates in the Iberian Peninsula and is extremely important both ecologically, as a key species for the functioning of the ecosystems, and economically, as a major game species. In Iberia, red deer populations are subjected to different management systems that may affect the physical condition of the individuals, with further consequences for population dynamics. Studies investigating the effects of management practices and environmental conditions on the performance of red deer are still rare regarding Mediterranean ecosystems. Much of the knowledge concerning the ecology of red deer and the impact of management on its physical condition is based on studies conducted in northern and central regions of Europe, where climatological features and management practices differ from those observed in the Mediterranean areas of Iberia. Studies on a biogeographical scale can provide important insights into the relationships between species and a particular environment and contribute to the development of more targeted and appropriate management practices. The optimisation of sampling procedures and the fine-tuning of pre-existing analytical techniques are also fundamental to a more cost-effective monitoring and, therefore, are of enormous value to wildlife managers. In this context, the main aims of this thesis were: 1) to optimise the procedures used to assess the physical condition of red deer; and 2) to identify relevant management and environmental factors affecting the nutritional condition and stress physiology of red deer in the Mediterranean ecosystems of Iberia, as well as any potential interactions between those factors. Two studies with a methodological focus, presented in the first part of the thesis, demonstrated that the physical condition of red deer can be evaluated more simply, using more cost- and time-effective procedures than those traditionally used: i) it was shown that only one kidney and its associated fat is enough to assess nutritional condition in red deer; and ii) the feasibility of using near infrared spectroscopy to predict the concentrations of stress hormone metabolites was demonstrated using faeces of red deer for the first time. Subsequently, two large-scale observational studies, conducted in representative red deer populations found in Mediterranean Iberia, highlighted the importance of considering seasonal environmental variations and variables related to hunting management practices to better understand the nutritional and physiological ecology of red deer. High population densities had adverse effects on the nutritional condition of the deer and were associated with increased stress levels in natural populations without supplementary feeding. Massive hunting events involving the use of hounds were also identified as a potential source of chronic stress in red deer. The research presented in this thesis has clear implications regarding the management and monitoring of red deer populations in Mediterranean environments and is intended to help wildlife managers to implement more effective monitoring programmes and sustainable management practices.

Irrigation management with remote sensing: Evaluating irrigation requirement for maize under Mediterranean climate condition

tWater use control methods and water resources planning are of high priority. In irrigated agriculture, theright way to save water is to increase water use efficiency through better management. The present workvalidates procedures and methodologies using remote sensing to determine the water availability in thesoil at each moment, giving the opportunity for the application of the water depth strictly necessaryto optimise crop growth (optimum irrigation timing and irrigation amount). The analysis is applied tothe Irrigation District of Divor, Évora, using 7 experimental plots, which are areas irrigated by centre-pivot systems, cultivated to maize. Data were determined from images of the cultivated surface obtainedby satellite and integrated with atmosphere and crop parameters to calculate biophysical indicatorsand indices of water stress in the vegetation—Normalized Difference Vegetation Index (NDVI), Kc, andKcb. Therefore, evapotranspiration (ETc) was estimated and used to calculate crop water requirement,together with the opportunity and the amount of irrigation water to allocate. Although remote sensingdata available from satellite imagery presented some practical constraints, the study could contribute tothe validation of a new methodology that can be used for irrigation management of a large irrigated area,easier and at lower costs than the traditional FAO recommended crop coefficients method. The remotesensing based methodology can also contribute to significant saves of irrigation water.

Conservative Management For Lingual Thyroid Ectopic.

Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with Tc(99m) and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years.

Laparoscopic nephrectomy outside gerota fascia for management of inflammatory kidney

Background and Purpose: A nonfunctioning inflammatory kidney is a challenging surgical condition for urologists. Some investigators recommend open surgery because of the surgical difficulties caused by the inflammatory process, whereas others try to apply the advantages of a ""simple"" non-hand-assisted laparoscopic approach. We report our experience with simple laparoscopic nephrectomy for inflammatory kidney management. Patients and Methods: From July 2002 through December 2006, 50 pure laparoscopic nephrectomies were performed for inflammatory kidney ( 43 because of pyelonephritis, 5 for xanthogranulomatous pyelonephritis (XGP), and 2 for pyonephrosis). Histopathologic analysis was the criterion used for inflammatory kidney diagnosis. Pain or recurrent urinary tract infection associated with a nonfunctioning excluded kidney was the eligibility criterion for the procedure. Preoperatively, all patients underwent complete image and functional renal assessment. Morcellation was used to remove surgical specimens. Conversion index, surgical difficulties, operative time, and postoperative complications were evaluated. Results: Conversion was performed in 14 of 50 (28%) patients, including two with XGP and one with pyonephrosis. Adhesions, vascular (two inferior vena cava) lesions, and intestinal lesions (two colon) were the main causes of conversion. Acute pancreatitis developed in one patient, and one patient had a wound infection. Reoperations were unnecessary, and no deaths occurred. Conclusion: Pure laparoscopic nephrectomy was successful in 72% of patients with inflammatory kidneys. The laparoscopic dissection was useful even in those cases converted to open surgery. This is a high-risk procedure, however, and both surgeon and patient must be aware of that before the decision is made for this approach.