Evaluación de resultados a dos y cinco años en técnicas antiincontinencia urinaria de Burch y cabestrillos suburetrales sin tensión.

Objetivo: Comparar los resultados de colposuspensión de Burch y colocación TVT en pacientes con incontinencia urinaria. Métodos: Estudio observacional, comparativo, retrospectivo de pacientes operadas de colposuspensión de Burch o colocación de cabestrillos vaginales libres de tensión (TVT) en el Hospital Universitario José Eleuterio González de 2002 a 2005, valorados a dos y cinco años por medio de la escala análoga visual, cuestionario sobre incontinencia urinaria y prueba de provocación. Resultados: A dos años, posteriores a los procedimientos, el porcentaje de éxito en las pacientes con colposuspensión de Burch fue de 80%; 15% referían mejoría significativa y sólo 5% se consideraron fracaso. Por otra parte, en los pacientes con TVT el éxito fue de 85%, mejoría de 12% y fracaso de 3%. A los cinco años pacientes con colposuspensión Burch el éxito fue de 76%, mejoría de 18% y con fracaso 6%; y para TVT los porcentajes fueron del 81%, 15% y 4% respectivamente. Conclusiones: Ambas técnicas quirúrgicas, son igualmente efectivas

Tratamiento de la vejiga hiperactiva. Estudio comparativo, experimental, aleatorizado de sulfato de atropina vs dimetilsulfóxido intravesical en 10 dosis intravesicales

Antecedentes: La vejiga hiperactiva tiene un efecto negativo significante sobre la ca-lidad de vida, reflejándose en aislamiento social y depresión. La urgencia urinaria se define como la imperiosa necesidad de micción, un síntoma característico del síndro-me de vejiga hiperactiva, los anti-muscarínicos son la primera línea de tratamiento para los síntomas de urgencia-frecuencia, sin embargo se asocian con efectos adver-sos que limitan su uso. Objetivo: Comparar el resultado de dos tratamientos intravesicales, el sulfato de atro-pina vs. dimetilsulfóxido (DMSO), para evaluar la efectividad en nicturia, capacidad vesical, frecuencia urinaria, urgencia urinaria y escala en calidad de vida en una mues-tra de pacientes con diagnóstico de vejiga hiperactiva. Métodos: Se realizó un estudio experimental longitudinal, prospectivo comparativo, aleatorizado en 14 mujeres con diagnóstico de vejiga hiperactiva comprobada por urodinamia en el Hospital Universitario Dr. José Eleuterio González. Las pacientes fueron divididas en dos grupos. En el grupo 1 (n = 7) se aplicaron 10 dosis intravesicales de 6.0 mg de sulfato de atropina diluidos en 20 mL de solución fisiológica; en el grupo 2 (n = 7) se aplicaron 10 dosis intravesicales de DMSO al 50% (25 mL a 100% diluidos en 25 mL de solución fisiológica). Se registraron como principales variables la frecuencia urinaria, nicturia, urgencia urinaria, capacidad vesical previa y posterior a tratamiento mediante urodinamia. Se evaluaron además con la encuesta de calidad de vida OAB-q en el estado basal y posterior al tratamiento. Resultados: Se observó una disminución en la frecuencia urinaria tanto en el grupo 1 de 9.25 ± 6.5 vs. 5.4 ± 1.1 (p = 0.002), como en el grupo 2 de 10.2 ± 4.42 vs. 6.8 ± 1.8, (p = 0.03). De igual manera, el grado de nicturia mejoró tanto en el grupo 1, 4.5 ± 2.78, y pos-terior al tratamiento de 0.55 ± 0.41 (p = 0.003) y el grupo 2 el nivel basal fue 3.14 ± 1.5

Fijación a ligamento sacroespinoso en el tratamiento y prevención del prolapso de cúpula vaginal: experiencia en el Hospital Universitario Dr. José Eleuterio González

El prolapso de cúpula vaginal se presenta como complicación tardía de la histerectomía abdominal o vaginal y afecta la calidad de vida de las pacientes. La fijación de cúpula vaginal es una opción de tratamiento y se ha utilizado también de manera profiláctica durante la histerectomía. Métodos: Se realizó un estudio prospectivo, longitudinal, descriptivo, no comparativo, no ciego, en 25 pacientes a quienes se les realizó fijación de cúpula vaginal a ligamento sacroespinoso en el Hospital Universitario Dr. José Eleuterio González de enero de 2005 a enero de 2008, dando seguimiento a un año con exploración física y cuestionarios de calidad de vida PFIQ-7 y PFDI-20. Resultados: De las 25 pacientes, con una edad media de 58 años, catorce tenían antecedente de histerectomía. Se realizó fijación de cúpula vaginal a ligamento sacroespinoso en nueve pacientes (36%), fijación de cúpula mas plastia vaginal a cinco pacientes (20%) e histerectomía vaginal más fijación a sacroespinoso mas plastia vaginal a 11 pacientes (44%), con una tasa de recurrencia de 8%. Se obtuvo mejoría significativa en el prolapso de cúpula vaginal (p ≤ 0.004), del cistocele (p ≤ 0.001) y rectocele (p ≤ 0.001), así como en la calidad de vida (p ≤ 0.000). Conclusiones: La fijación de cúpula vaginal al ligamento sacroespinoso ha demostrado ser una técnica efectiva en el tratamiento y prevención del prolapso de cúpula vaginal, corroborando en nuestro estudio lo descrito en la literatura

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

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

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

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