Factores pronósticos en el traumatismo craneoencefálico grave

Introduction: Severe head injury is one of the leading causes of death and disability in the population, especially among young males. Method: A retrospective, descriptive study was conducted to evaluate the prognostic factors for patients with severe head injury during the first 24 hours after the injury, and its final evolution in the Intensive Care Unit of the Arnaldo Milian Castro Provincial University Hospital Universitario in Santa Clara in a five-year period. The study included all patients admitted with a diagnosis of severe head trauma. Results: A total of 113 patients were studied, with 44 deaths for a mortality rate of 38.9%. The patients aged 45 or over were a total of 52, of these 27 died (61.4%) giving a relative risk of dying of 1.86. The neurological variables studied, as the Glasgow Coma Scale with a score of 6 points or less had a RR of 3.19, those with pupillary abnormalities had a relative risk of 2.80. Those with an ischemic cerebral hemodynamic pattern, and a high pulsatility index, had a relative risk of 2.21 and 1.86 respectively. The non-neurological variables studied were hyperglycemia, with a relative risk of 3.26; hypernatremia – in 25 patients – with a relative risk of 3.21; systolic blood pressure below 90 mm Hg, a SaO2 below 90% and the presence of metabolic acidosis, with relative risks of 3.03, 2.16 and 2.65 respectively. A prognostic scale was developed with non-neurological and neurological variables, with a score of 0 - 19 points. In it, it was observed that when the score was above 6 points the mortality rate was higher than 50%. Conclusions: The variables studied show a high probability of death in the first 24 hours after the severe head injury, with the proposal of a prognostic scale of mortality in these patients.Introducción: Los traumatismos craneoenfálicos  graves constituyen una de las primeras causas de mortalidad e incapacidad en la población joven y sobre todo al sexo masculino. Método: Se realizó un estudio retrospectivo, descriptivo para evaluar los factores pronósticos de los pacientes con traumatismo craneoencefálico grave en las primeras 24 horas después del evento y su evolución final en la Unidad de Cuidados Intensivos del Hospital Universitario “Arnaldo Milián Castro” de la Ciudad de Santa Clara en un período de cinco años, incluyéndose en el estudio todos los pacientes ingresados con el diagnóstico de traumatismo craneoencefálico grave. Resultados: Se estudiaron un total de 113 pacientes con 44 fallecidos para un 38.9% de mortalidad; se trata de  pacientes con edades de 45 o más años, fueron un total de 52 y de esos fallecieron 27 (61.4%) dando un riesgo relativo de fallecer de 1.86. Las variables neurológicas estudiadas como la Escala de Coma de Glasgow con una puntuación de 6 puntos o menos presentaron un RR de 3.19, aquellos que presentaron alteraciones pupilares tuvieron  un riesgo relativo de 2.80, los que presentaron un patrón hemodinámico cerebral isquémico y un índice de pulsatilidad alto, el riesgo relativo fue de 2.21 y 1.86 respectivamente. Las variables no neurológicas estudiadas fueron la hiperglicemia con un riesgo relativo de 3.26, la hipernatremia -en 25 pacientes- con un riesgo relativo de 3.21, la tensión arterial sistólica por debajo de 90 mm Hg, una SaO2 por debajo de 90% y la presencia de una acidosis metabólica con riesgo relativo 3.03, 2.16 y 2.65 respectivamente. Se elaboró una escala pronóstica con las variables neurológicas y no  neurológicas  con una puntuación de 0-19 puntos donde se observó que cuando la puntuación se encontraba por encima de 6 puntos la mortalidad era superior al 50%. Conclusiones: Las variables estudiadas muestran una alta probabilidad de mortalidad en las primeras 24 horas después del traumatismo craneoencefálico grave con la propuesta de una escala pronóstica de mortalidad en dichos pacientes

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Measurement of B-c(2S)(+) and B-c*(2S)(+) cross section ratios in proton-proton collisions at root s=13 TeV

Peer reviewe

Reconstruction of signal amplitudes in the CMS electromagnetic calorimeter in the presence of overlapping proton-proton interactions

A template fitting technique for reconstructing the amplitude of signals produced by the lead tungstate crystals of the CMS electromagnetic calorimeter is described. This novel approach is designed to suppress the contribution to the signal of the increased number of out-of-time interactions per beam crossing following the reduction of the accelerator bunch spacing from 50 to 25 ns at the start of Run 2 of the LHC. Execution of the algorithm is sufficiently fast for it to be employed in the CMS high-level trigger. It is also used in the offline event reconstruction. Results obtained from simulations and from Run 2 collision data (2015-2018) demonstrate a substantial improvement in the energy resolution of the calorimeter over a range of energies extending from a few GeV to several tens of GeV.Peer reviewe

Observation of the Production of Three Massive Gauge Bosons at root s=13 TeV

The first observation is reported of the combined production of three massive gauge bosons (VVV with V = W, Z) in proton-proton collisions at a center-of-mass energy of 13 TeV. The analysis is based on a data sample recorded by the CMS experiment at the CERN LHC corresponding to an integrated luminosity of 137 fb(-1). The searches for individualWWW, WWZ, WZZ, and ZZZ production are performed in final states with three, four, five, and six leptons (electrons or muons), or with two same-sign leptons plus one or two jets. The observed (expected) significance of the combinedVVV production signal is 5.7 (5.9) standard deviations and the corresponding measured cross section relative to the standard model prediction is 1.02(-0.23)(+0.26). The significances of the individual WWW and WWZ production are 3.3 and 3.4 standard deviations, respectively. Measured production cross sections for the individual triboson processes are also reported

MUSiC : a model-unspecific search for new physics in proton-proton collisions at root s=13TeV

Results of the Model Unspecific Search in CMS (MUSiC), using proton-proton collision data recorded at the LHC at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9 fb(-1), are presented. The MUSiC analysis searches for anomalies that could be signatures of physics beyond the standard model. The analysis is based on the comparison of observed data with the standard model prediction, as determined from simulation, in several hundred final states and multiple kinematic distributions. Events containing at least one electron or muon are classified based on their final state topology, and an automated search algorithm surveys the observed data for deviations from the prediction. The sensitivity of the search is validated using multiple methods. No significant deviations from the predictions have been observed. For a wide range of final state topologies, agreement is found between the data and the standard model simulation. This analysis complements dedicated search analyses by significantly expanding the range of final states covered using a model independent approach with the largest data set to date to probe phase space regions beyond the reach of previous general searches.Peer reviewe

Measurement of prompt open-charm production cross sections in proton-proton collisions at root s=13 TeV

The production cross sections for prompt open-charm mesons in proton-proton collisions at a center-of-mass energy of 13TeV are reported. The measurement is performed using a data sample collected by the CMS experiment corresponding to an integrated luminosity of 29 nb(-1). The differential production cross sections of the D*(+/-), D-+/-, and D-0 ((D) over bar (0)) mesons are presented in ranges of transverse momentum and pseudorapidity 4 < p(T) < 100 GeV and vertical bar eta vertical bar < 2.1, respectively. The results are compared to several theoretical calculations and to previous measurements.Peer reviewe