Allergic Rhinitis and its Associated Co-Morbidities at Bugando Medical Centre in Northwestern Tanzania; A Prospective Review of 190 Cases.

Allergic rhinitis is one of the commonest atopic diseases which contribute to significant morbidity world wide while its epidemiology in Tanzania remains sparse. There was paucity of information regarding allergic rhinitis in our setting; therefore it was important to conduct this study to describe our experience on allergic rhinitis, associated co-morbidities and treatment outcome in patients attending Bugando Medical Centre. This was descriptive cross-sectional study involving all patients with a clinical diagnosis of allergic rhinitis at Bugando Medical Centre over a three-month period between June 2011 and August 2011. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 17.0. A total of 190 patients were studied giving the prevalence of allergic rhinitis 14.7%. The median age of the patients was 8.5 years. The male to female ratio was 1:1. Adenoid hypertrophy, tonsillitis, hypertrophy of inferior turbinate, nasal polyps, otitis media and sinusitis were the most common co-morbidities affecting 92.6% of cases and were the major reason for attending hospital services. Sleep disturbance was common in children with adenoids hypertrophy (χ2 = 28.691, P = 0.000). Allergic conjunctivitis was found in 51.9%. The most common identified triggers were dust, strong perfume odors and cold weather (P < 0.05). Strong perfume odors affect female than males (χ2 = 4.583, P = 0.032). In this study family history of allergic rhinitis was not a significant risk factor (P =0.423). The majority of patients (68.8%) were treated surgically for allergic rhinitis co morbidities. Post operative complication and mortality rates were 2.9% and 1.6% respectively. The overall median duration of hospital stay of in-patients was 3 days (2 - 28 days). Most patients (98.4%) had satisfactory results at discharge. The study shows that allergic rhinitis is common in our settings representing 14.7% of all otorhinolaryngology and commonly affecting children and adolescent. Sufferers seek medical services due to co-morbidities of which combination of surgical and medical treatment was needed. High index of suspicions in diagnosing allergic rhinitis and early treatment is recommended

On the traceably accurate voltage calibration of electrostatic accelerators

We describe in detail a calibration method for the terminal voltage of small accelerators used for ion beam analysis, with the elastic resonance of 16O(α,α)16O at 3038 keV as the intrinsic measurement standard. The beam energy relative to this resonance is determined with a precision around 300 eV and an evaluated reproducibility of 1.0 keV. We show that this method is both robust and convenient, and demonstrate consistency with calibration relative to three other independent methods: using radioactive sources and using the resonant 27Al(p,γ)28Si and non-resonant 16O(p,γ)17F direct capture reactions. We re-evaluate the literature and show that the peak in the cross-section function is at 3038.1 ± 2.3 keV. By comparing the results obtained with 16O(α,α)16O to the other calibration methods we show that this uncertainty can be reduced to 1.3 keV.</p

The impact of airway-irritating exposure and wet work on subjects with allergy or other sensitivity - epidemiology and mechanisms

Sammanfattning -- Förekomsten av astma och andra allergier ökar, vilket betyder att andelen av arbetare på arbetsmarknaden med allergi eller annan överkänslighet också ökar. Det är inte känt på vilket sätt dessa personer med en ökad känslighet i luftvägar och hud påverkas av exponeringar för irriterande ämnen på arbetsplatsen. Huvudsyftet med den här avhandlingen var att undersöka hur personer med allergi och annan överkänslighet är exponerade på arbetet i jämförelse med friska personer, och vad hälsoeffekterna blir för personer som får en luftvägs- eller huddiagnos tidigt i livet. En jobbexponeringsmatris (JEM) för svenska förhållanden, innehållande bedömningar av luftvägsirriterande exponering och våtarbete utvecklades i Studie I. JEMen applicerades på två stora populationskohorter, Värnpliktskohorten och Folkhälsoenkäten. I båda kohorterna hade personer med astma exponerade arbeten nästan lika ofta som friska personer, medan personer med allergisk rinit mer sällan hade jobb bedömda som exponerade. Våtarbete var vanligare hos arbetare med symptom som vanligtvis orsakas av yrkesexponering (handeksem), än hos arbetare med symptom som utvecklas i barndomen (atopiskt eksem). I Studie II studerades hälsokonsekvenserna av att ha en luftvägsdiagnos i Värnpliktskohorten, vilket visade att personer med astma hade en ökad risk för sjuklighet och dödlighet jämfört med friska personer och personer med allergisk rinit. I Studie III-V studerades exponering för inhalerade partiklar, speciellt dos till lungan och lungans genomsläpplighet för ultrafina förbränningspartiklar. I samarbete med en tysk forskargrupp modifierade vi en metod för att kunna framställa radioaktiva ultrafina kolpartiklar. Partiklarna inhalerades av personer med astma, rökare och friska personer. Med den modifierade metoden fick vi fram partiklar med en stabil storlek och med en stabil bindning mellan partikeln och radiomärkningen, vilket är en förutsättning när man följer partiklar inuti kroppen under en lägre tid. Det fanns ingen mätbar translokering av de ultrafina partiklarna från lungorna till andra delar av kroppen. Dosen till lungan var däremot högre hos personer med astma och hos rökare, jämfört med hos friska personer. Sammanfattningsvis är en ökande andel av arbetskraften idag extra känslig och reagerar med symptom redan vid låga nivåer av exponeringar i arbetsmiljön. För att kunna ge bra information och utveckla preventionen måste vi först veta var insatserna behövs. Med hjälp av en JEM för luftvägsirriterande ämnen kan man hitta samband mellan känsliga grupper och exponeringar, något vi har dålig kunskap om idag. Denna avhandling har visat att det finns känsliga grupper som vi vet har hög sjukfrånvaro och arbetslöshet, och ofta har arbetsbyten och 37 psykosociala problem, men som trots det inte självmant undviker exponeringar som påverkar hälsan negativt. Resultaten i denna avhandling stödjer inte hypotesen att känsliga grupper kan få en högre dos av partiklar till målorgan på grund av att fler partiklar translokerar. Det är däremot möjligt att den högre dos av partiklar till lungan som vi såg hos känsliga försökspersoner kan medverka till systemiska effekter. Mer forskning krävs för att utreda om även en minimal translokering av partiklar är tillräcklig för att orsaka skadliga effekter.----------------------The prevalence of asthma and allergies is increasing, which means that the proportion of workers on the labour market with allergy or other sensitivity also increases. It is as of yet not known to what extent these persons with an elevated sensitivity in the airways or the skin are affected by exposure to irritating substances at work. The main aims of this thesis were to investigate how subjects with allergy or other sensitivity are exposed at work places compared to healthy subjects and consequences of an airway diagnosis early in life. A job-exposure matrix (JEM) for Swedish conditions, for estimation of airway irritating exposure and wet work was developed in Study I. The JEM was applied on two large population cohorts, the Conscription cohort and the People Health Survey. In both cohorts, subjects with asthma had exposed jobs to nearly the same extent as healthy subjects, while subjects with allergic rhinitis rarely had jobs assessed as exposed. Wet work was more associated to symptoms caused by occupational exposure (hand eczema) than to symptoms appearing in childhood (atopic eczema). In Study II the consequences of an airway diagnosis for health was studied in the Conscription cohort, which revealed that asthmatic subjects had an increased risk for morbidity and mortality compared to healthy subjects and subjects with allergic rhinitis. In Study III-V the exposure to inhaled particles was studied, especially the lung deposition and permeability of ultrafine combustion particles. In collaboration with a German research group we modified a method for the production of ultrafine radiolabelled combustion particles. Asthmatics, smokers and healthy subjects inhaled the particles. The modified method yielded particles with a stable radioactive label and a stable particle size, making it a suitable method for the study of inhaled particles. We found that the translocation from the lungs to the circulation was negligible for both 100 nm and 35 nm particles. The dose to the lung was however higher in subjects with asthma and in smokers, compared to in healthy subjects. In conclusion, an increasing proportion of the workers today is sensitive and reacts with symptoms already at low levels of airway-irritating exposure. To be able to give appropriate information and develop prevention, we have to know where efforts are needed. With a JEM for airway-irritating agents it is possible to find associations between sensitive groups and exposure, something that we have poor knowledge of today. This thesis has revealed some sensitive groups that do 35 not voluntarily avoid health detrimental exposures, groups that are known to have poor health, high unemployment and absence due to sickness. We found little evidence for the hypothesis that the vulnerability of susceptible individuals should be a consequence of a higher direct dose of particles to target organs. It is, however, possible that a higher particle dose to the lung contribute to systemic effects. More research is needed to establish if a minimal fraction of translocated particles is sufficient to cause harmful effects

Framtidens hållbara elbilskoncept : En jämförande LCA-studie mellan en elbil och en bränslecellsbil

Transportsektorn så som den ser ut i dagens samhälle är inte hållbar då den står för ungefär 30 % av Sveriges totala utsläpp av koldioxid. Detta beror framför allt på att fossila bränslen utgör det främsta drivmedlet inom transportsektorn, och alternativa lösningar måste därför undersökas. Två sådana alternativ är elbilar och bränslecellsbilar. För att ta reda på vilket av dessa elbilskoncept som har störst möjlighet att skapa en utsläppsfri transportsektor har livscykelanalyser genomförts för att jämföra de olika bilmodellerna ur ett livscykelperspektiv. De två bilmodeller som betraktas i studien är elbilen Tesla Model S och bränslecellsbilen Hyundai ix35 Fuel Cell. Analysen omfattar produktionen av de för bilmodellernas specifika komponenter, vilket för elbilen är batteriet och för bränslecellsbilen bränslecellen, vätgastankarna och batteriet, samt användningsfasen där även produktion av bränsle ingår. Distribution och återvinning av bilmodellerna har uteslutits ur denna studie. För genomförandet av livscykelanalyserna har programvaran SimaPro 7 som ger tillgång till ett stort antal databaser använts. Resultatet av studien visar att bränslecellsbilen har en lägre klimatpåverkan än en elbil sett ur ett livscykelperspektiv, med antagandet att vätgasen produceras med vattenkraftsproducerad el. Dock finns det en del osäkerheter i studien så som val av bilmodeller, material och processer vid produktionsfasen som kan ha påverkat resultatet. För att minska eventuella osäkerheter i beräkningarna undersöktes ytterligare två scenarion; ett där vätgasen som används i bränslecellsbilen producerats med en genomsnittlig svensk elproduktion och ett där ett mindre batteri användes i elbilen. Enligt resultatet av det första scenariot är bränslecellsbilen även då det bästa alternativet ur miljösynpunkt, medan elbilen skulle vara ett bättre alternativ om storleken på batteriet var mindre. Avslutningsvis kan konstateras att den största klimatpåverkan för de båda elbilskoncepten sker under produktionsfasen. Särskilt utmärkande är detta för elbilen, medan bränslecellsbilen har en högre klimatpåverkan under användningsfasen. Oavsett vilket av de undersökta elbilskoncepten som används kommer Sveriges transportsektor inte kunna bli koldioxidneutral inom den närmsta framtiden, och det är även svårt att avgöra vilket av koncepten som lämpar sig bäst för användning i större skala i en framtida svensk transportsektor. The transport sector in today’s society is not sustainable since it contributes to about 30% of Sweden’s total greenhouse gas emissions. This is mainly due to the fact that the primary fuels used in the transport sector are fossil fuels. Therefore, alternative solutions must be investigated. Two such options that will be investigated in this report are battery electric vehicles and fuel cell vehicles. To find out which of these would have a greater possibility to create a zero-emission transport sector, the vehicles have been compared from a life cycle perspective by the performance of a life cycle assessment. The investigated vehicle models are the battery electric vehicle Tesla Model S and the fuel cell vehicle Hyundai ix35 Fuel Cell. The assessment includes production of the specific components for each vehicle, which are defined as the battery in the battery electric vehicle and the fuel cell, hydrogen tanks and battery in the fuel cell vehicle, along with the use phase and production of the fuel. Distribution and recycling of the vehicles have been excluded from the study. The software SimaPro 7, which gives access to several life cycle inventory databases, was used when performing the life cycle assessments. According to the result of the study, fuel cell vehicles have a lower impact on the climate than battery electric vehicles from a life cycle perspective, if the hydrogen is produced using hydroelectric energy. However, a number of uncertainties such as differences in the chosen vehicle models, and assumptions made regarding the materials and processes used in the production phase of the vehicles could have affected the result. Two additional scenarios were investigated to decrease these uncertainties; one where the hydrogen used in the fuel cell vehicle was produced using an average Swedish electricity production and one where a smaller size of the battery in the battery electric vehicle was used. In the first scenario, the fuel cell vehicle would still be the better option, but in the scenario where a smaller size of the battery was used, the battery electric vehicle would be the option with the lowest impact on the climate. It can be concluded that the greater part of the climate impact from the two vehicle concepts occurs during the production phase, particularly for the battery electric vehicle. The fuel cell vehicle, on the other hand, has a greater impact on the climate during the use phase. Regardless of which of the investigated electric vehicle concepts is used, it is not possible for the Swedish transport sector to become climate neutral within the near future, and it is also difficult to determine which concept would be more suitable for a large-scale usage in the future Swedish transport sector.

The Untapped Potential of Hydropower

The operation of hydropower plants in Sweden is regulated by certain Water Rights Permit. When new permits are to be applied for, for instance when wanting to make an upgrade or build new units or hydropower plants, this is done through an application process. This application process can be long and complex, and it has uncertain outcomes. Energy companies such as Fortum may therefore at times avoid applying for new permits, which results in an untapped potential of power output for the hydropower plants in question. The objective of this master thesis is to investigate how these application processes have impacted the power output from hydropower plants. This aspect is important due to expected changes in the legislation, which may increase the rate at which these applications for new permits are made. It is therefore important to learn from past processes and take these lessons into consideration in future cases. To investigate this, a number of case studies have been conducted in order to see which considerations have been made regarding whether or not to apply for new permits. Through investigation and evaluation regarding how different criteria impacts on the case studies, it was found that each case was unique. Different studied aspects affected the application process to a different extent, and at different stages. Some combinations, such as suggesting building a new hydropower plant or unit if the surrounding area is under protection according to the Environmental Code, were shown to impact the process and its outcome extensively in the studied cases. It was shown that a lot of potential upgrades have not been realized. An increase of only 10 %, out of an estimated potential of 26 %, was actually achieved in the studied cases. When comparing to other reports in the same field, it was shown that even further potential could be reached if using a systems approach

The Untapped Potential of Hydropower

The operation of hydropower plants in Sweden is regulated by certain Water Rights Permit. When new permits are to be applied for, for instance when wanting to make an upgrade or build new units or hydropower plants, this is done through an application process. This application process can be long and complex, and it has uncertain outcomes. Energy companies such as Fortum may therefore at times avoid applying for new permits, which results in an untapped potential of power output for the hydropower plants in question. The objective of this master thesis is to investigate how these application processes have impacted the power output from hydropower plants. This aspect is important due to expected changes in the legislation, which may increase the rate at which these applications for new permits are made. It is therefore important to learn from past processes and take these lessons into consideration in future cases. To investigate this, a number of case studies have been conducted in order to see which considerations have been made regarding whether or not to apply for new permits. Through investigation and evaluation regarding how different criteria impacts on the case studies, it was found that each case was unique. Different studied aspects affected the application process to a different extent, and at different stages. Some combinations, such as suggesting building a new hydropower plant or unit if the surrounding area is under protection according to the Environmental Code, were shown to impact the process and its outcome extensively in the studied cases. It was shown that a lot of potential upgrades have not been realized. An increase of only 10 %, out of an estimated potential of 26 %, was actually achieved in the studied cases. When comparing to other reports in the same field, it was shown that even further potential could be reached if using a systems approach