Carros de emergência: disponibilidade dos itens essenciais em um hospital de urgência norteriograndense

It is a descriptive, exploratory and quantitative study that evaluates, by the standards of the Brazilian Society of Cardiology (SBC), the availability of the items of the Level I Emergency Cars (EC) of the largest emergency hospital in Rio Grande do Norte. Data were collected during the month of November 2010, the sample consists of 12 EC. All EC analyzed showed gaps in availability of essential items, being the greatest deficiencies related to materials intended for vascular access, circulation control and drugs aimed at treating the causes of cardiac arrest. It was felt institution, as well as a protocol, difficult routine check of the EC, the nurse assigned task.Se trata de una investigación descriptiva, exploratoria y cuantitativa con el objetivo de evaluar, bajo los patrones de la Sociedad Brasileña de Cardiología (SBC), la disponibilidad de los artículos de nivel I de los Carros de Emergencia (CE) del mayor hospital de urgencia de Rio Grande do Norte. Los datos fueron colectados durante el mes de noviembre de 2010, estando compuesta la muestra por 12 CE. Todos los CE analizados presentaron fallos en la disponibilidad de artículos esenciales, estando las mayores deficiencias relacionadas con los materiales destinados al acceso vascular, control circulatorio y medicamentos dirigidos al tratamiento de las causas de PCR. Se percibe que la falta de recursos humanos y materiales en la institución, así como de un protocolo, dificulta la rutina de comprobación del CE, tarea atribuída al enfermero.Trata-se de uma pesquisa descritiva, exploratória e quantitativa com o objetivo de avaliar, sob os padrões da Sociedade Brasileira de Cardiologia (SBC), a disponibilidade dos itens de nível I dos Carros de Emergência (CE) do maior hospital de urgência do Rio Grande do Norte. Os dados foram coletados durante o mês de novembro de 2010, sendo a amostra composta por 12 CE. Todos os CE analisados apresentaram falhas na disponibilidade de itens essenciais, estando as maiores deficiências relacionadas aos materiais destinados ao acesso vascular, controle circulatório e medicamentos voltados ao tratamento das causas de PCR. Percebeu-se que a falta de recursos humanos e materiais na instituição, bem como de um protocolo, dificulta a rotina de checagem do CE, tarefa atribuída ao enfermeiro

Phenotypic Variability of Childhood Charcot-Marie-Tooth Disease

IMPORTANCE: Disease severity of childhood Charcot-Marie-Tooth disease (CMT) has not been extensively characterized, either within or between types of CMT to date. OBJECTIVE: To assess the variability of disease severity in a large cohort of children and adolescents with CMT. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study was conducted among 520 children and adolescents aged 3 to 20 years at 8 universities and hospitals involved in the Inherited Neuropathies Consortium between August 6, 2009, and July 31, 2014, in Australia, Italy, the United Kingdom, and the United States. Data analysis was conducted from August 1, 2014, to December 1, 2015. MAIN OUTCOMES AND MEASURES: Scores on the Charcot-Marie-Tooth Disease Pediatric Scale (CMTPedS), a well-validated unidimensional clinical outcome measure to assess disease severity. This instrument includes 11 items assessing fine and gross motor function, sensation, and balance to produce a total score ranging from 0 (unaffected) to 44 (severely affected). RESULTS: Among the 520 participants (274 males) aged 3 to 20 years, CMT type 1A (CMT1A) was the most prevalent type (252 [48.5%]), followed by CMT2A (31 [6.0%]), CMT1B (15 [2.9%]), CMT4C (13 [2.5%]), and CMTX1 (10 [1.9%]). Disease severity ranged from 1 to 44 points on the CMTPedS (mean [SD], 21.5 [8.9]), with ankle dorsiflexion strength and functional hand dexterity test being most affected. Participants with CMT1B (mean [SD] CMTPedS score, 24.0 [7.4]), CMT2A (29.7 [7.1]), and CMT4C (29.8 [8.6]) were more severely affected than those with CMT1A (18.9 [7.7]) and CMTX1 (males: 15.3 [7.7]; females: 13.0 [3.6]) (P < .05). Scores on the CMTPedS tended to worsen principally during childhood (ages, 3-10 years) for participants with CMT4C and CMTX1 and predominantly during adolescence for those with CMT1B and CMT2A (ages, 11-20 years), while CMT1A worsened consistently throughout childhood and adolescence. For individual items, participants with CMT4C recorded more affected functional dexterity test scores than did those with all other types of CMT (P < .05). Participants with CMT1A and CMTX1 performed significantly better on the 9-hole peg test and balance test than did those with all other types of CMT (P < .05). Participants with CMT2A had the weakest grip strength (P < .05), while those with CMT2A and CMT4C exhibited the weakest ankle plantarflexion and dorsiflexion strength, as well as the lowest long jump and 6-minute walk test distances (P < .05). Multiple regression modeling identified increasing age (r = 0.356, β = 0.617, P < .001) height (r = 0.251, β = 0.309, P = .002), self-reported foot pain (r = 0.162, β = .114, P = .009), and self-reported hand weakness (r = 0.243, β = 0.203, P < .001) as independent predictors of disease severity. CONCLUSIONS AND RELEVANCE: These results highlight the phenotypic variability within CMT genotypes and mutation-specific manifestations between types. This study has identified distinct functional limitations and self-reported impairments to target in future therapeutic trials

Numerical and experimental analysis of wrinkling during the cup drawing of an AA5042 aluminium alloy

The recent trend to reduce the thickness of metallic sheets used in forming processes strongly increases the likelihood of the occurrence of wrinkling. Thus, in order to obtain defect-free components, the prediction of this kind of defect becomes extremely important in the tool design and selection of process parameters. In this study, the sheet metal forming process proposed as a benchmark in the Numisheet 2014 conference is selected to analyse the influence of the tool geometry on wrinkling behaviour, as well as the reliability of the developed numerical model. The side-wall wrinkling during the deep drawing process of a cylindrical cup in AA5042 aluminium alloy is investigated through finite element simulation and experimental measurements. The material plastic anisotropy is modelled with an advanced yield criterion beyond the isotropic (von Mises) material behaviour. The results show that the shape of the wrinkles predicted by the numerical model is strongly affected by the finite element mesh used in the blank discretization. The accurate modelling of the plastic anisotropy of the aluminium alloy yields numerical results that are in good agreement with the experiments, particularly the shape and location of the wrinkles. The predicted punch force evolution is strongly influenced by the friction coefficient used in the model. Moreover, the two punch geometries provide drawn cups with different wrinkle waves, mainly differing in amplitude.The authors gratefully acknowledge the financial support of the Portuguese Foundation for Science and Technology (FCT) under project PTDC/EMS-TEC/1805/2012. The first author is also grateful to the FCT for the Postdoctoral grant SFRH/BPD/101334/2014 and P.D. Barros is grateful to the FCT for the PhD Grant SFRH/BD/98545/2013info:eu-repo/semantics/publishedVersio

Stabilization of dense Antarctic water supply to the Atlantic Ocean overturning circulation

The lower limb of the Atlantic overturning circulation is resupplied by the sinking of dense Antarctic Bottom Water (AABW) that forms via intense air–sea–ice interactions next to Antarctica, especially in the Weddell Sea. In the last three decades, AABW has warmed, freshened and declined in volume across the Atlantic Ocean and elsewhere, suggesting an ongoing major reorganization of oceanic overturning. However, the future contributions of AABW to the Atlantic overturning circulation are unclear. Here, using observations of AABW in the Scotia Sea, the most direct pathway from the Weddell Sea to the Atlantic Ocean, we show a recent cessation in the decline of the AABW supply to the Atlantic overturning circulation. The strongest decline was observed in the volume of the densest layers in the AABW throughflow from the early 1990s to 2014; since then, it has stabilized and partially recovered. We link these changes to variability in the densest classes of abyssal waters upstream. Our findings indicate that the previously observed decline in the supply of dense water to the Atlantic Ocean abyss may be stabilizing or reversing and thus call for a reassessment of Antarctic influences on overturning circulation, sea level, planetary-scale heat distribution and global climate

Numerical modeling of the thermal contact in metal forming processes

Heat flow across the interface of solid bodies in contact is an important aspect in several engineering applications. This work presents a finite element model for the analysis of thermal contact, which takes into account the effect of contact pressure and gap dimension in the heat flow across the interface between two bodies. Additionally, the frictional heat generation is also addressed, which is dictated by the contact forces predicted by the mechanical problem. The frictional contact problem and thermal problem are formulated in the frame of the finite element method. A new law is proposed to define the interfacial heat transfer coefficient (IHTC) as a function of the contact pressure and gap distance, enabling a smooth transition between two contact status (gap and contact). The staggered scheme used as coupling strategy to solve the thermomechanical problem is briefly presented. Four numerical examples are presented to validate the finite element model and highlight the importance of the proposed law on the predicted temperature.The authors gratefully acknowledge the financial support of the Portuguese Foundation for Science and Technology (FCT) under the project PTDC/EMS-TEC/1805/2012 and by FEDER funds through the program COMPETE Programa Operacional Factores de Competitividade, under the project CENTRO-07-0224- FEDER-002001 (MT4MOBI). The second author is also grateful to the FCT for the postdoctoral grant SFRH/BPD/101334/2014. The authors would like to thank Prof. A. Andrade-Campos for helpful contributions on the development of the finite element code presented in this work.info:eu-repo/semantics/publishedVersio

Observation of the Baryonic Flavor-Changing Neutral Current Decay Lambda_b -> Lambda mu+ mu-

We report the first observation of the baryonic flavor-changing neutral current decay Lambda_b -> Lambda mu+ mu- with 24 signal events and a statistical significance of 5.8 Gaussian standard deviations. This measurement uses ppbar collisions data sample corresponding to 6.8fb-1 at sqrt{s}=1.96TeV collected by the CDF II detector at the Tevatron collider. The total and differential branching ratios for Lambda_b -> Lambda mu+ mu- are measured. We find B(Lambda_b -> Lambda mu+ mu-) = [1.73+-0.42(stat)+-0.55(syst)] x 10^{-6}. We also report the first measurement of the differential branching ratio of B_s -> phi mu+ mu- using 49 signal events. In addition, we report branching ratios for B+ -> K+ mu+ mu-, B0 -> K0 mu+ mu-, and B -> K*(892) mu+ mu- decays.Comment: 8 pages, 2 figures, 4 tables. Submitted to Phys. Rev. Let

Teeth of the red fox Vulpes vulpes (L., 1758) as a bioindicator in studies on fluoride pollution

An examination was made of fluoride content in the mandibular first molars of the permanent teeth of the red fox Vulpes vulpes living in north-west (NW) Poland. The teeth were first dried to a constant weight at 105°C and then ashed. Fluorides were determined potentiometrically, and their concentrations were expressed in dry weight (DW) and ash. The results were used to perform an indirect estimation of fluoride pollution in the examined region of Poland. The collected specimens (n = 35) were classified into one of the three age categories: immature (im, 6–12 months), subadult (subad, from 12 to 20 months) and adult (ad, >20 months). The mean concentrations (geometric mean) of fluoride were similar in the im and subad groups (230 and 296 mg/kg DW and 297 and 385 mg/kg ash, respectively), and significantly smaller than in the ad group (504 and 654 mg/kg, respectively, in DW and ash). Basing on other reports that the ∼400 mg/kg DW concentration of fluoride in bones in the long-lived wild mammals generally reflects the geochemical background, it was found that 57% of the foxes in NW Poland exceeded this value by 9% to 170%. This indirectly reflects a moderate fluoride contamination in the tested region