Dissertations / Theses on the topic 'Material follows'

Objectives: The study examined the way mothers’ narratives about her child change during the early years of motherhood and to assess if these changes are meaningfully associated with parent infant relationships and maternal psychopathology. Method: The study followed 76 mother-infant dyads over a 12 month period from two socially disadvantaged community samples: a normative group and a clinically referred group. Maternal representations were measured using the Reflective Functioning (RF) scale and the 10 PDI (Wain, 2010), a dimensional coding system developed for the Parent Development Interview (PDI). The mother-infant relationship was rated using the Emotional Availability Scale. Maternal psychopathology was measured in terms of depressive symptomatology, parental stress and symptoms of distress. All measures were conducted at baseline and at 12 month follow up. Results: Maternal psychopathology at both time points was concurrently associated with more evidence of emotional distress, hostility and helplessness, and less evidence of maternal support in PDI narratives. Over the 12 month study period we observed a decrease in levels of maternal psychopathology and increased maternal emotional availability reflected in concurrent adaptive change in the PDI narratives. Behavioural observations of child involvement with mother at Time 2 were predicted by more enmeshed/role-reversed maternal representations at Time 1. However, child responsiveness in mother-infant interactions at Time 2 was predicted by evidence of supportive maternal representations at Time 1. Conclusions: The results are interpreted in terms of the role of maternal representations in the emerging relationship between mother and infant.

Dissertação (mestrado) - Pontifícia Universidade Católica do Paraná, Curitiba, 2004
Inclui bibliografia
O trabalho desenvolve uma análise, em sede de Dogmática Jurídica, das normas que regulam a tributação sobre o comércio exterior no direito brasileiro. Para tanto, parte de questões relevantes de Filosofia e de Teoria Geral do Direito, de Direito Constituc
The work develops na Jurisprudence analisys of the norms that regulate the taxation on the foreign commerce in the Brazillian law. For in such a way, starts with important questinos of Philosophy and General Theory of the Jurisprudence, of Constitucional

Aim: To investigate the clinical survival and success, including both function and aesthetics, of tooth supported crowns in the anterior region after a minimum of 5 years after installation in the student as well as teacher clinic of the Faculty of Odontology, Malm. University, Sweden. Materials & method: Eligible patients were identified through screening of dental technician invoices stretching back to 2012. 78 patients were invited to participate in the study and 39 patients were examined, 28 and 11 from student and teacher clinics respectively. A modified examination protocol based on the CDA protocol was used by two examiners to score the crowns. Moreover, patients’ own views on aesthetics and function of their crowns were collected through a questionnaire. Results: Patient satisfaction with function and aesthetics was equally high in teacher and student clinic as well as for the different crown materials. Examiner ratings found overall successful results across the investigated categories “surface and colour”, “anatomic form” and “margin integrity”. No significant differences were found with regards to the operator or the different materials. The 5-year survival rate among the examined patients was 89% resp. 91% in the student and teacher clinic. Conclusion: Patients at the Faculty of Odontology in Malm. can expect to receive satisfying crown treatments in the anterior region of the mouth regardless of whether the operator is a teacher or a student and regardless of the chosen material.
Syfte: Att undersöka klinisk överlevnad och lyckandefrekvens, med hänsyn till funktion och estetik, av tandstödda kronor i framtandsregionen som installerades för minst 5 år sedan på student och lärarklinik vid Odontologiska fakulteten, Malmö Universitet, Sverige. Material och metod: 78 lämpliga patienter identifierades genom granskning av  tandtekniska fakturor från 2012 och framåt, och bjöds in att delta i studien. 39 patienter undersöktes, 28 respektive 11 från student- och lärarklinik. Två granskare använde ett modifierat granskningsprotokoll baserat på CDA protokollet för att betygsätta kronornas utseende och funktion. Utöver detta användes ett frågeformulär för att få patientens syn på estetik och funktion av kronan. Resultat: Patienternas omdömen av kronans funktion och estetik var lika hög i lärar- och studentkliniken liksom för de olika kronmaterialen. Granskarnas bedömning visade hög lyckandefrekvens för de undersökta kategorierna ”yta och färg”, ”anatomisk form” och ”kantanslutning”. Inga signifikanta skillnader kunde ses med avseende på vem som var operatör eller vilket material som valts. 5-års överlevnaden bland de undersökta patienterna var 89% resp. 91% p. student- och lärarkliniken. Slutsats: Patienter som behandlas vid Odontologiska fakulteten i Malmö kan förvänta sig ett tillfredsställande resultat vid kronterapi i framtandsregionen oavsett om operatören är en lärare eller en student och oavsett vilket material som väljs.

Abstract The aim of this study was to follow 8 to 36- month old children's communicative development and its' associations with social-emotional skills (the Brief Infant Toddler Social-Emotional Assessment, BITSEA) and behavioural problems. This study is the first study using the Finnish version of the BITSEA. A total of 50 children participated in the Oulu region (first phases at year 2006 and 2007). At the age of 8 months (at year 2006, n =  31), child participants were grouped into two conditions: 1) children possibly needing support for deficiencies in communicative and interaction skills and 2) children without noted areas of need of support in communicative and interaction skills. Through random sampling, three groups were formed and included children from both the above mentioned conditions. The groups met fortnightly for five months for a directed song-play session (enrichment intervention). The sample size was increased at year 2007 (n =  19) and follow-up questionnaires were sent to all of the participating families (N =  50) at the child's age of 18, 24 and 36 months. The sample during the year 2007 did not receive any intervention. Results suggest, that the children's communicative and social-emotional development may be linked to each other. Children who scored higher in the assessments in communicative skills were also more successful on assessments measuring social interaction and social-emotional competence. Children with better communication skills demonstrated higher scores after enrichment-intervention. Scores on the BITSEA demonstrated an association with other indicators of children's development employed in the study suggesting the utility of the BITSEA as a follow-up assessment in Finnish sample. Mothers, who rated high maternal stress (measured at the child's age of 8 months) also rated higher levels of social-emotional and behavioural problems in their children, especially when a child was 18 months. This effect appeared to decrease over time. Results indicate the clinical importance of directly measuring not only a child's linguistic and social-emotional development, but also including assessment of a child's immediate environment, such as parents and siblings
Tiivistelmä Tutkimuksen tarkoituksena oli seurata 8-36 kuukauden ikäisten lasten kielellistä kehitystä ja sen yhteyttä sosioemotionaaliseen kehitykseen (Brief Infant Toddler Social-Emotional Assessment, BITSEA-lomake) sekä käyttäytymisen ongelmiin. Tämä oli ensimmäinen tutkimus Suomessa, jossa käytettiin BITSEAn suomenkielistä versiota. Tutkimukseen osallistui 50 perhettä (aloitus vuosina 2006 ja 2007) Oulun alueelta. Kahdeksan kuukauden iässä täytettyjen lomakkeiden perusteella (vuonna 2006, n =  31) lapset luokiteltiin vuorovaikutus- ja kommunikaatiotaitojen mukaan kahteen joukkoon: 1) Vuorovaikutus- ja kommunikaatiotaitojen tukea mahdollisesti tarvitsevat lapset ja 2) Lapset, joilla ei todennäköisesti ollut tuen tarvetta vuorovaikutus- ja kommunikaatiotaidoissa. Satunnaisotannalla muodostettiin kolme pienryhmää (rikastuttamisryhmät), joihin kuului sekä mahdollista tukea tarvitsevia että tukea tarvitsemattomia lapsia. Ryhmät kokoontuivat joka toinen viikko viiden kuukauden ajan ohjattuun laulu-leikkituokioon. Tutkimusta laajennettiin syksyllä 2007 (n =  19) ja kaikille tutkimukseen osallistuneille perheille (N = 50) lähetettiin seurantalomakkeita, jotka vanhempien tuli täyttää lapsen ollessa 18, 24 ja 36 kuukauden ikäinen. Vuoden 2007 otoksen perheille ei tarjottu perheinterventiota. Tutkimuksessa kävi ilmi, että lapset, jotka saivat korkeat pisteet sosioemotionaalista kompetenssia kuvaavissa kartoituksissa, menestyivät paremmin myös vuorovaikutus- ja kommunikaatiotaitoja kuvaavissa arvioinneissa. Lapset, joilla oli jo ennestään korkeammat pisteet vuorovaikutus- ja kommunikaatiotaitoja kuvaavissa lomakkeissa, näyttivät saavan korkeammat pisteet myös intervention jälkeen. Tutkimuksessa tuli esiin, että BITSEA -lomake korreloi hyvin muiden lasten kehityksen seurannassa käytettyjen mittareiden kanssa ja soveltuu siten hyvin tutkimuslomakkeeksi suomalaisessakin aineistossa. Lisäksi äidit, jotka arvioivat stressitasonsa korkealle (lapsen ollessa kahdeksan kuukauden ikäinen), arvioivat myöhemmin myös korkeampia pisteitä lasten sosioemotionaalisten ja käyttäytymisen ongelmien kyselylomakkeissa lapsen ollessa 18 kuukauden ikäinen. Tämä vaikutus kuitenkin väheni lapsen kasvaessa. Tutkimustulokset osoittavat, että perhe- ja neuvolatyössä on lapsen kehityksen kannalta tärkeää huomioida myös hänen kasvuympäristönsä; vanhempien hyvinvointi ja sisarusten määrä vaikuttavat lapsen kielelliseen ja sosioemotionaaliseen kehitykseen

Objective: This study was completed as a follow up to research regarding buprenorphine Medication Assisted Therapy (MAT) in Johnson City Tennessee for-profit clinics. We wished to determine the practice patterns over the last three years. Methods: Johnson City for-profit Medical Assisted Therapy clinics were called with a telephone survey. When the clinic representative answered the phone, they were asked questions regarding patient costs for therapy, insurance coverage, counseling offered on site, and opportunities for tapering while 20 weeks pregnant. Results: At all the MAT clinics contacted, the representative informed us that tapering in pregnancy could be considered contrary to current national guidelines. 43% of the clinics are now accepting insurance as compared to 0% in the 2016 study. The average weekly cost per visit remained consistent. Conclusion: The concept of tapering buprenorphine during pregnancy appears to have become a standard of care for this community and it is offered at all of the clinics that were contacted, some even require it, even though national organizations such as American College of Obstetricians and Gynecologists and American Society of Addiction Medicine; do not recommend this approach. Patients who have insurance including government funded insurance, are now able to obtain buprenorphine with no out of pocket expense at numerous clinics. The high cost for the uninsured patient continues to create an environment conducive to buprenorphine diversion.

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Clinical-laboratory follow-up after an accident with biological material should be performed at occupational exposures with a positive or unknown source. The objective of this study was to analyze the epidemiology of occupational accidents with exposure to biological material among health workers who abandoned clinical-laboratory follow-up. Cohort study developed from work accidents registered in the SINAN (National Institute of Public Health) Information System between 2006 and 2016 in the city of Goiania - Goias. Data were analyzed in Stata with descriptive and analytical statistics. During the study period, 7,265 accidents were reported. Of these, 2,104 exposures were analyzed and the majority of the workers were females, with completed high school and belonged to the nursing team. The accidents occurred mostly due to percutaneous injury (72.6%), involving lumen needles (56.1%) which were used for drug administration or vascular access puncture. In most exposures (60.1%) the resource person was known and the most recommended prophylaxis was chemoprophylaxis against VIH. The dropout rate of clinical and laboratory follow-up was 41.5%. In the multivariate analysis, it was observed that the chances of interruption of follow-up were higher among workers aged 40 or over, belonging to the nursing, dentistry and cleaning staff, who were not using personal protective equipment (apron) at the time of exposure, were injured by other objects that were not a lumen needle, were working on the books, had not been issued with a work accident report and refused chemoprophylaxis against VIH. It was also observed that the injured persons exposed during procedures in the laundry or in the washing of material presented less chance of drop-out. It is concluded that the interruption of follow-up is a multifactorial event, influenced by the care offered after the exposure, the support of the employer and the convictions of the injured.
O acompanhamento clínico-laboratorial após acidente com material biológico deve ser realizado nas exposições ocupacionais com fonte positiva ou desconhecida. O objetivo deste estudo foi analisar a epidemiologia do abandono do acompanhamento clínico – laboratorial entre trabalhadores da área da saúde que sofreram exposição a material biológico. Estudo de coorte, desenvolvido a partir dos acidentes de trabalho registrados no Sistema de Informação de Agravos de Notificação (SINAN) entre 2006 – 2016 no município de Goiânia - Goiás. Os dados foram analisados no Stata com estatística descritiva e analítica. Haviam 7.265 acidentes notificados no período do estudo. Desses foram avaliadas 2.104 exposições, nas quais a maioria dos trabalhadores era do sexo feminino, tinha ensino médio completo e pertencia a equipe de enfermagem, cujos acidentes ocorreram com maior frequência por lesão percutânea (72,6%), envolvendo agulhas com lúmen (56,1%), que foram utilizadas para administração de medicamentos ou punção de acesso vascular. Na maioria das exposições (60,1%) a pessoa fonte era conhecida e a conduta profilática mais recomendada foi a quimioprofilaxia contra o VIH. A taxa de abandono do acompanhamento clínico – laboratorial foi de 41,5%. Na análise multivariada verificou-se que as chances de interrupção do seguimento foram maiores entre os trabalhadores com idade igual ou maior a 40 anos, pertencentes às equipes de enfermagem, odontologia e do serviço de limpeza, que não estavam utilizando o avental no momento da exposição, sofreram lesão por outros objetos que não eram agulha com lúmen, trabalhavam com carteira assinada, não tiveram a emissão da comunicação de acidente de trabalho e recusaram a quimioprofilaxia contra o VIH. Constatou-se ainda que os acidentados expostos durante a realização de procedimentos na lavanderia ou na lavagem de material apresentaram menor chance de abandono. Frente a elevada taxa de abandono encontrada sugere-se a implementação de estratégias para garantir o seguimento e reduzir o risco para o trabalhador.

Maternal morbidity is physical ill health related to pregnancy and childbirth or any maternal complication during pregnancy, labour and puerperium. Severe maternal morbidity is a life-threatening obstetric complication. The importance of severe maternal morbidity is that it precedes maternal mortality and is therefore critical in the understanding of the factors that influence maternal mortality. The overall aim of the study was to investigate risk factors associated with severe maternal morbidity and progression to maternal mortality in Mulago hospital, Kampala, Uganda. The study had two stages: Stage 1 was an unmatched case-control study of severe maternal morbidity and Stage 2 was a follow-up of all cases from Stage 1 to discharge or death. A total of 499 cases of severe maternal morbidity and 500 controls (women with normal deliveries and no severe maternal morbidity) were studied. Both the cases and controls were interviewed to obtain information on socio demographic factors, previous obstetric outcomes and present obstetric performance. Information on obstetric management was extracted from clinical notes. All cases and controls were tested for HIV, syphilis and haemoglobin level. A total of 39 of the 499 severe maternal morbidity cases died. The causes of SMM were severe pre eclampsia (25%), severe dystocia (31%) Post partum haemorrhage (19%), ante partum haemorrhage (14%) puerperal sepsis (5%) and medical diseases (6%). The main risk factors for severe maternal morbidity were low socio economic class, long distance from home to Mulago hospital, having specific medical conditions, having to request permission to attend health unit, having a long interval since the last birth, HIV positive status and poor quality of care during antenatal and delivery. Further details, plus separate analyses of specific causes of SMM (eclampsia, post partum haemorrhage, severe dystocia and ante partum haemorrhage) are presented. Determinants of progression to maternal death included low socio economic class, factors associated with management of labour, and HIV/AIDS. The main conclusion from this work is that improvements in the social and economic status of women, the level of HIV in the community, and the quality of care offered 2 during pregnancy will reduce the burden of severe maternal morbidity and mortality in Kampala, Uganda. It is likely that these results can be generalised to other areas of sub-Saharan Africa and usefully integrated into Safe-Motherhood Programs there.

Doutoramento em Química
Chapter 1 introduces the scope of the work by identifying the clinically relevant prenatal disorders and presently available diagnostic methods. The methodology followed in this work is presented, along with a brief account of the principles of the analytical and statistical tools employed. A thorough description of the state of the art of metabolomics in prenatal research concludes the chapter, highlighting the merit of this novel strategy to identify robust disease biomarkers. The scarce use of maternal and newborn urine in previous reports enlightens the relevance of this work. Chapter 2 presents a description of all the experimental details involved in the work performed, comprising sampling, sample collection and preparation issues, data acquisition protocols and data analysis procedures. The proton Nuclear Magnetic Resonance (NMR) characterization of maternal urine composition in healthy pregnancies is presented in Chapter 3. The urinary metabolic profile characteristic of each pregnancy trimester was defined and a 21-metabolite signature found descriptive of the metabolic adaptations occurring throughout pregnancy. 8 metabolites were found, for the first time to our knowledge, to vary in connection to pregnancy, while known metabolic effects were confirmed. This chapter includes a study of the effects of non-fasting (used in this work) as a possible confounder. Chapter 4 describes the metabolomic study of 2nd trimester maternal urine for the diagnosis of fetal disorders and prediction of later-developing complications. This was achieved by applying a novel variable selection method developed in the context of this work. It was found that fetal malformations (FM) (and, specifically those of the central nervous system, CNS) and chromosomal disorders (CD) (and, specifically, trisomy 21, T21) are accompanied by changes in energy, amino acids, lipids and nucleotides metabolic pathways, with CD causing a further deregulation in sugars metabolism, urea cycle and/or creatinine biosynthesis. Multivariate analysis models´ validation revealed classification rates (CR) of 84% for FM (87%, CNS) and 85% for CD (94%, T21). For later-diagnosed preterm delivery (PTD), preeclampsia (PE) and intrauterine growth restriction (IUGR), it is found that urinary NMR profiles have early predictive value, with CRs ranging from 84% for PTD (11-20 gestational weeks, g.w., prior to diagnosis), 94% for PE (18-24 g.w. pre-diagnosis) and 94% for IUGR (2-22 g.w. pre-diagnosis). This chapter includes results obtained for an ultraperformance liquid chromatography-mass spectrometry (UPLC-MS) study of pre-PTD samples and correlation with NMR data. One possible marker was detected, although its identification was not possible. Chapter 5 relates to the NMR metabolomic study of gestational diabetes mellitus (GDM), establishing a potentially predictive urinary metabolic profile for GDM, 2-21 g.w. prior to diagnosis (CR 83%). Furthermore, the NMR spectrum was shown to carry information on individual phenotypes, able to predict future insulin treatment requirement (CR 94%). Chapter 6 describes results that demonstrate the impact of delivery mode (CR 88%) and gender (CR 76%) on newborn urinary profile. It was also found that newborn prematurity, respiratory depression, large for gestational age growth and malformations induce relevant metabolic perturbations (CR 82-92%), as well as maternal conditions, namely GDM (CR 82%) and maternal psychiatric disorders (CR 91%). Finally, the main conclusions of this thesis are presented in Chapter 7, highlighting the value of maternal or newborn urine metabolomics for pregnancy monitoring and disease prediction, towards the development of new early and non-invasive diagnostic methods.
O Capítulo 1 descreve o enquadramento deste trabalho identificando as doenças pré-natais relevantes e os métodos de diagnóstico actualmente disponíveis. É depois apresentada a metodologia seguida, assim como uma breve introdução dos princípios dos métodos analíticos e estatísticos aplicados. O capítulo é concluído com uma descrição do estado da arte na área de metabolómica em investigação pré-natal, identificando o mérito desta inovadora estratégia para a identificação de marcadores robustos de doenças pré-natais. A relevância deste trabalho torna-se clara através do escasso uso de urina materna e do recém-nascido em trabalhos anteriores. O Capítulo 2 descreve os procedimentos experimentais utilizados neste trabalho, incluindo condições de amostragem, recolha e preparação das amostras, protocolos de aquisição e de tratamento dos dados. A caracterização da composição da urina materna, através de espectroscopia de Ressonância Magnética Nuclear (RMN) de protão é apresentada no Capítulo 3. Define-se o perfil metabólico urinário característico para cada trimestre de gravidez, tendo sido encontrado um conjunto de 21 metabolitos descritivo das alterações metabólicas ocorridas ao longo da gravidez. 8 metabolitos foram encontrados a variar com a gravidez, pela primeira vez, tendo sido confirmadas variações metabólicas conhecidas. É ainda estudado o efeito do não-jejum (usado neste trabalho) como possível factor de confusão. O Capítulo 4 apresenta o estudo metabolómico de urina materna do 2º trimestre para o diagnóstico de doenças fetais e previsão de complicações mais tarde desenvolvidas. Este estudo compreende a aplicação de um método de selecção de variáveis desenvolvido no âmbito desta tese. Observou-se que as malformações fetais (e, especificamente, do sistema nervoso central, SNC) e as cromossomopatias (e, especificamente, a trissomia 21, T21) são acompanhadas por alterações nos metabolismos energético, dos aminoácidos, lípidos e nucleótidos, enquanto que as cromossomopatias mostraram ser acompanhadas por uma desregulação adicional dos metabolismos dos açúcares, ciclo da ureia e/ou biossíntese da creatinina. A validação dos modelos multivariados revelou taxas de classificação (CR) de 84% para malformações (87%, SNC) e 85% para CD (94%, T21). Para o parto pré-termo, pré-eclampsia (PE) e restrição de crescimento intrauterino (RCIU) observaram-se perfis que podem ajudar à previsão precoce, com CR 84% para pretermo (11-20 semanas de gestação, g.w. pré-diagnóstico), 94% para PE (18-24 g.w. pré-diagnóstico) e 94% para RCIU (2-22 g.w. pré-diagnóstico). Este capítulo inclui resultados obtidos por cromatografia líquida de ultra eficiência acoplada a espectrometria de massa (UPLC-MS) para pré-pretermo e correlação com os dados de RMN. Um possível composto marcador foi detectado mas a sua identificação não foi possível. O Capítulo 5 descreve o estudo metabolómico por RMN da diabetes mellitus gestacional (DMG), estabelecendo-se um perfil metabólico potencialmente preditivo da doença (CR 83%, 2-21 g.w. pré-diagnóstico). Verificou-se ainda que o espectro de RMN contém informação sobre o fenótipo individual, capaz de prever a necessidade futura de tratamento com insulina (CR 94%). No Capítulo 6 demonstra-se o impacto do tipo de parto (CR 88%) e género do bebé (CR 76%) no perfil da urina do recém-nascido. Verificou-se ainda que a prematuridade, depressão respiratória, crescimento grande para a idade gestacional e malformações induzem perturbações metabólicas relevantes (CR 82-92%), assim como algumas doenças maternas como a DMG (CR 82%) e doenças psiquiátricas (91% CR). Finalmente, no Capítulo 7 apresentam-se as principais conclusões deste trabalho, enfatizando o potencial da metabolómica de urina materna e do bebé para o acompanhamento da gravidez e previsão de doenças, visando o desenvolvimento de novos métodos de diagnóstico precoce e não-invasivo.

Doutoramento em Bioquímica
The work presented in this thesis aimed to investigate the impact of healthy pregnancy and selected prenatal disorders on the metabolome and lipidome of maternal blood plasma, in order to define new potential biomarkers for non-invasive prediction and diagnosis. Chapter 1 describes the present status and challenges of the clinically relevant prenatal disorders, along with a presentation of the metabolomics strategy applied and the state of the art of metabolomics in prenatal research. All experimental details are described in Chapter 2, comprising sample metadata, sample collection and preparation, data acquisition protocols and data analysis procedures. The plasma metabolome and lipidome viewed by 1D and 2D NMR experiments are presented in Chapter 3. In this chapter, the use of Multiple Quantum NMR spectroscopy was explored, for the first time, for assignment of complex lipid mixtures. Chapter 4 contributes to filling in some existing gaps regarding human plasma degradability during handling and storage, as well as the importance of fasting conditions at collection. The use of heparin collection tubes resulted in no interference of the polysaccharide and full conservation of spectral information, while EDTA tubes produced a number of interfering signals from free and Ca2+/Mg2+ complexed EDTA, the impact of which on metabolomic analysis is discussed. Regarding temperature stability, large changes in lipoproteins and choline compounds were observed in plasma kept at room temperature for  2.5 hours, whereas short-term storage at -20ºC was found suitable up to 7 days, with storage at -80ºC being recommended, particularly for long-term periods (at least up to 2.5 years). Regarding freeze-thaw cycles, no more than 3 consecutive cycles were found advisable, while the use of non-fasting conditions (instead of fasting) was found acceptable. Chapter 5 presents the first NMR metabolomics study of maternal plasma throughout pregnancy, including correlation between plasma and urine metabolites. Some of the metabolic alterations observed confirmed known metabolic effects, while novel changes were observed, suggesting adjustments in energy and gut microflora metabolisms (citrate, lactate and dimethyl sulfone) and alterations in glomerular filtration rate (creatine and creatinine). Correlations studies unveiled specific lipoprotein/protein metabolic aspects of healthy pregnancy with impact on the excreted metabolome, providing further understanding of pregnancy metabolism. In Chapter 6, the impact of prenatal disorders on maternal plasma metabolome and lipidome is described for fetal chromosomal disorders (CD), including Trisomy 21 (T21). High classification rates were obtained for CD (88-89%) and T21 (85-92%) in 1st and 2nd trimesters, based on variable selection of NMR data. In addition, novel metabolic deviations were found through plasma/urine correlations, namely in low density and very low density lipoproteins (LDL+VLDL), sugar and gut microflora metabolisms. Changes in plasma phospholipid profile, namely in phosphatidylcholines, were further confirmed and characterised by hydrophilic interaction liquid chromatography-mass spectrometry (HILIC-LC/MS). In Chapter 7, metabolic biomarkers of pre- and post-diagnosis GDM were sought by NMR metabolomics of whole maternal plasma and plasma lipid profile in the 2nd trimester. Metabolic alterations found to be predictive of GDM comprised increases in cholesterol, fatty acids, triglycerides and small metabolites changes in glucose, amino acids, betaine, urea, creatine and metabolites related with gut microflora. Post-diagnosis GDM was successfully classified using a 26-resonance plasma biomarker corresponding to 10 metabolites and lipids, advancing the possibility of using a multi-metabolite biomarker as a complementary tool in the clinical management of GDM. Chapter 8 describes the results obtained for prenatal disorders shown to have lower impact on maternal plasma metabolome, namely diagnosed fetal malformations and pre-diagnosis premature rupture of membranes, preterm delivery and preeclampsia. Finally, Chapter 9 describes the general conclusions and future perspectives in the context of this thesis, highlighting how this work contributes with new knowledge on prenatal disease mechanisms and possible biomarkers for prenatal diagnosis and prediction methods.
O trabalho apresentado nesta tese teve como principal objetivo investigar o impacto da gravidez saudável e algumas doenças pré-natais no metaboloma e lipidoma de plasma sanguíneo materno, com vista à definição de novos biomarcadores para a previsão e diagnóstico não invasivos daquelas doenças. O Capítulo 1 descreve a perspectiva atual e os desafios das doenças pré-natais mais relevantes, assim como a estratégia metabolómica e estado da arte na investigação pré-natal. Todos os detalhes experimentais do trabalho realizado estão descritos no Capítulo 2, incluindo as condições de amostragem, recolha e preparação das amostras, bem como os protocolos de aquisição e análise dos dados. No Capítulo 3 descreve-se o metaboloma e lipidoma de plasma detectados por RMN 1D e 2D. Neste capítulo, a utilização de espectroscopia de RMN de quantum-múltiplo foi explorada, pela primeira vez, para caracterização de misturas lipídicas complexas. O Capítulo 4 contribui para colmatar algumas falhas no conhecimento sobre a degradibilidade do plasma humano durante o manuseamento da amostra e armazenamento, e a importância de condições de colheita como o jejum. A utilização de tubos de colheita com heparina não mostrou interferência do polissacarídeo nos espectros conservando-se toda a informação espectral, enquanto que os tubos com EDTA deram origem a sinais interferentes provenientes do EDTA livre e complexado com Ca2+/Mg2+, cujo impacto na análise metabolómica é discutido. Relativamente à estabilidade do plasma à temperatura ambiente, foram observadas alterações nas lipoproteínas e compostos de colina a partir de 2.5 horas, enquanto que o armazenamento a -20ºC mostrou ser adequado até 7 dias, sendo o armazenamento a -80ºC aconselhado, particularmente para períodos de tempo longos (pelo menos até 2.5 anos). Relativamente aos ciclos de congelação-descongelação, não se aconselham mais de 3 ciclos consecutivos, enquanto que o efeito da colheita das amostras em não-jejum (em vez de jejum) foi considerado aceitável. O Capítulo 5 apresenta o primeiro estudo de metabolómica por RMN do plasma materno ao longo da gravidez, incluindo correlação entre plasma e urina. Algumas das alterações metabólicas observadas confirmaram efeitos metabólicos conhecidos, tendo outras sido observadas pela primeira vez sugerindo alterações no metabolismo energético, na microflora bacteriana (citrato, lactato e dimetil sulfona) e na taxa de filtração glomerular (creatina e creatinina). Os estudos de correlação revelaram aspetos metabólicos específicos das lipoproteínas/proteínas com impacto no metaboloma excretado. No Capítulo 6 descreve-se o impacto das doenças cromossómicas (CD), incluindo Trissomia 21 (T21) no metaboloma e lipidoma de plasma materno. Obtiveram-se elevadas taxas de classificação para CD (88-89%) e T21 (85-92%) no 1º e 2º trimestres baseadas na seleção de variáveis dos dados de RMN. A correlação de plasma e urina revelou novos desvios metabólicos, nomeadamente no metabolismo das lipoproteínas de baixa densidade e de muito baixa densidade (LDL+VLDL), dos açúcares e da microflora bacteriana. As alterações observadas no perfil de fosfolípidos do plasma, nomeadamente das fosfatidilcolinas, foram confirmadas e caracterizadas por cromatografia liquida hidrofílica acoplada a espetrometria de massa (HILIC-LC/MS). No Capítulo 7 apresentam-se os resultados obtidos na prospecção de biomarcadores metabólicos de diabetes mellitus gestacional (GDM) pré- e pós-diagnóstico por metabolómica de RMN de plasma materno do 2º trimestre. Observaram-se alterações metabólicas com poder de previsão de GDM, nomeadamente um aumento no colesterol, ácidos gordos, triglicerídeos e pequenas variações metabólicas na glucose, aminoácidos, betaína, ureia, creatina e metabolitos relacionados com a microflora bacteriana. O grupo de GDM pós-diagnóstico foi bem classificado utilizando como biomarcador um conjunto de 26 ressonâncias do espectro de plasma correspondendo a lípidos e 10 metabolitos de baixo peso molecular, sugerindo-se a possibilidade de usar este marcador conjunto na gestão clínica da GDM. O Capítulo 8 descreve os resultados obtidos para as doenças pré-natais que mostraram ter um menor impacto no metaboloma de plasma materno, nomeadamente as malformações fetais (FM), e os estados de pré-diagnóstico da rutura prematura das membranas (PROM), parto pré-termo (PTD) e pré-eclampsia. Finalmente, no Capítulo 9 são descritas as conclusões gerais e perspetivas futuras no contexto desta tese, realçando-se como este trabalho contribui para o novo conhecimento dos mecanismos das doenças pré-natais e possíveis biomarcadores para a sua previsão e diagnóstico.

Background: Obesity in pregnancy, and excessive gestational weight gain, are associated with short and long-term adverse health outcomes for mothers and their offspring, including childhood obesity. The Healthy Eating and Lifestyle in Pregnancy (HELP) cluster randomised controlled trial compared the effectiveness of a group-based weight management intervention, delivered during pregnancy and postpartum, with National Health Service routine maternity care. In total, 598 pregnant women, aged 18 years and over, with a BMI of ≥30 kg/m2, and between 12 and 20 weeks gestation, were recruited across 20 study centres in England and Wales, United Kingdom. The aim of the HELP trial was to improve health outcomes in these women with obesity. The present study followed up these women and their children at 24 months postpartum and aimed to assess longer-term maternal and child outcomes. It also aimed to explore the experiences of these women. Methods: A sequential mixed methods approach was used. The first, quantitative phase, examined the effectiveness of the HELP intervention on primary outcomes, maternal BMI and child BMI-for-age z-scores, and secondary outcomes, including weight, diet, and physical activity behaviours of mothers and children. Outcomes were analysed using multilevel linear, logistic and ordinal regression models. The second, qualitative phase, used telephone interviews to explore women's experiences. Thematic analysis was used to organise and interpret the interview data. Findings from the two approaches were triangulated for discussion. Results: The 24 months postpartum follow-up included 241 women and children, across 19 clusters. The analyses found no evidence of between groups differences in the primary outcomes, maternal BMI at 24 months postpartum (adjusted percentage difference: -0.01, 95% CI -0.04 to 0.02; ICC < 0.001; p= 0.664) and child BMI-for-age z-scores (adjusted difference in means: 0.24, 95% CI -0.17 to 0.64; ICC < 0.001; p=0.250), or the secondary outcomes. Subsequently, 18 of these women completed a telephone interview. Maternal attitudes towards their own and their child's weight and health behaviours, before, during and after pregnancy, were described in three themes: 1) pregnancy specific attitudes and behaviours; 2) wider weight control attitudes and experiences; and, 3) maternal perceptions and influences on children's weight, diet and activity. Discussion: The HELP intervention did not improve outcomes for women and their children at 24 months postpartum. Women have a strong desire to be healthy for their unborn babies during pregnancy. Non-judgmental support may help them adopt healthier behaviours to achieve short-term goals. However, more support would be needed to help women achieve better long-term outcomes. Women's lived experiences of obesity are complex, and it is important to incorporate their beliefs and motivations into interventions. Rather than viewing pregnancy as a short window of opportunity for initiating behaviour change, it should be used as a unique motivator which could give women a purpose for change over a longer term. Exploring options for intervening in the preconception period to address attitudes and weight loss before pregnancy, supporting women during pregnancy to be healthy for their babies, and building on this postpartum to help women shift their goals to weight loss, self-regulation of weight management, being a positive role model for their children and health-promoting feeding practices; may be more effective for improving maternal and child outcomes.

Orientador: Regina Yu Shon Chun
Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Introdução: O predomínio do componente neonatal sobre o pós-natal na mortalidade infantil, nas décadas de 1980 e 90 no Brasil, trouxe em evidência a elevada proporção de óbitos evitáveis e a importância da qualidade assistencial mãe-bebê. A especialização, o desenvolvimento de tecnologias, a valorização e capacitação de recursos humanos além do estabelecimento de políticas públicas de saúde voltadas à Atenção Materno-Infantil contribuíram para maior sobrevida de bebês com graves intercorrências perinatais. Tais fatos contribuíram para a criação de Ambulatórios de Follow Up, proporcionado por programas longitudinais como o Centro de Referência em Desenvolvimento Infantil Fênix - CRDI (Campinas, SP, Brasil). O serviço segue as diretrizes da Política Nacional de Humanização, buscando superar a fragmentação da rede e do processo de trabalho e recebeu reconhecimento do Ministério da Saúde em 2006, tendo sido inserido no Banco de Projetos do Humanizasus. O Programa Nacional Avaliação de Serviços de Saúde alerta sobre a importância de mecanismos de avaliação e de controle da qualidade assistencial bem como da opinião daqueles aos quais os serviços se destinam. Assim, este estudo volta-se à avaliação desse Programa por meio da análise de indicadores de avaliação do serviço e da perspectiva do cuidador. Objetivo: Avaliar a assistência do CRDI-FÊNIX por meio de (i) indicadores de oferta (capacidade de oferta do serviço), da demanda de encaminhamento e de chegada, de cobertura (proporção da população-alvo atingida pelo programa/intervenção), e de utilização (proporção de uso do serviço da população alvo) e (ii) entrada, acompanhamento multidisciplinar, qualidade e resolutividade da assistência e vínculo entre usuário/cuidador/equipe na opinião do cuidador. Sujeitos e métodos: Trata-se de pesquisa retrospectiva aprovada pelo Comitê de Ética e Pesquisa. Foi feito levantamento dos sujeitos que receberam alta de junho de 2005 a julho de 2006 para constituição do corpus e caracterização do perfil da população atendida. Resultados: Os prontuários caracterizaram os bebês quanto a: local de moradia, tempo médio de seguimento e profissionais envolvidos na assistência. A adesão foi de 53% dos sujeitos e demanda de encaminhamento da maternidade de referência de 28,77%. A demanda de chegada ao serviço foi de 83,22% e a capacidade de oferta estimada em 140 bebês/ano. Verifica-se que do total de nascimentos, 10,74% dos bebês foram encaminhados para cuidados intensivos e intermediários, sendo que 6,09% pertenciam ao Sistema Único de Saúde. Desses, chegaram ao serviço 1,60% por apresentarem risco para alteração no desenvolvimento neuropsicomotor. A utilização integral do serviço foi de 52,78% e a parcial, 47,22%. Os cuidadores indicam satisfação quanto a qualidade, resolutividade da assistência e a importância do acompanhamento multidisciplinar. Conclusão: Os achados mostram a eficácia dos indicadores estudados e reiteram a importância da escuta e do acolhimento ao usuário em uma perspectiva humanizada e integral, mostrando-se como ferramentas fundamentais para conhecimento e avaliação do serviço. A responsabilização dos diferentes sujeitos implicados no processo dessa rede de cuidados contribui para desburocratização da assistência e para maior autonomia dos atores envolvidos, exercendo-se a humanização, como proposta pelas políticas vigentes
Abstract: Introduction: The prevalence of the neonatal component over the post-neonatal in infant mortality, in the decades of 1980 and 1990 in Brazil, showed the high proportion of avoidable deaths and the importance of the care quality mother-baby. The specialization, the development of technologies, the valuing and capacity of human resources in addition to the establishment of public health policies aiming the Mother-Child attention, contributed for a highest survival of babies with severe perinatal interferences. These facts contributed to the creation of High-risk Infant Follow-up Program , provided by longitudinal programs such as the Fenix Reference Center in Children Development - CRDI (Campinas, SP, Brazil). The service follows the guidelines from the National Policy of Humanization, aiming to overcome the system and work process fragmentation and was recognized by the Ministry of Health in 2006, being inserted in Humanizasus projects database. The National Program of Health Services Assessment warns about the importance of assessment tools and of assistential quality control such as the opinion of those at whom the service is aimed. Therefore, this study aims to evaluate this program through the analysis of the service assessment indicators and the caregiver perspective. Objective: To evaluate the assistance of CRDI-FENIX through (i) provision indicators (capacity of service provision), incoming and referral demand, coverage (proportion of target population that is assisted by the program/intervention) and use (proportion of the service use by target population) and (ii) incoming, multidisciplinary assistance, quality assistence, solving assistance and attachment between the user/caregiver/staff according to the caregiver opinion. Subjects and methods: This is a retrospective research approved by Research Ethics Committee. A survey was done on subjects that received medical discharge during the period of June 2005 to July 2006, composing the corpus and the population characterization. For the analysis of the target population that was assisted by the program, it were used data from July 2007 to June 2008, since the reference maternity did not have the data from 2005 and 2006. Results: The subject records categorized the babies according to: the place of their residences, average period of assistance, and professional involved in assistance. The adherence was of 53% and referral demand from the reference maternity was 28.77%. The incoming demand to the service was 83.22% and the offer capacity estimated of 140 babies per year. The results showed that from the total of the new bourns, 10,74% need intensive care, from that 6,09% are dependent from the Brazilian Unified Health System (SUS) and 1.6% arrived at the service. The integral use of the service was 52.78% and parcial 47.22%. The caregivers showed satisfaction regarding the quality and solving of the assistance, and the importance of the multidisciplinary assistance. Conclusion: The findings revealed the efficiency of the indicators studied and reiterate the importance of the user's listening and embracement according to a humanized and integral perspective, considered as important tools to know and evaluate the service. The responsibility of the different subjects involved in the process of this care network contributes for the disbureaucracy of the assistance and for a greater independence of the people involved, considering the humanization as a proposal from the current politics
Mestrado
Saude, Interdisciplinaridade e Reabilitação
Mestre em Saúde, Interdisciplinaridade e Reabilitação

Abstract Early risk factors of the antenatal period and infancy have been increasingly linked to psychiatric disorders. The aim of this thesis was to study the associations between very early parental separation and maternal depressed mood in pregnancy on the other hand, and schizophrenia and criminality in the offspring in adolescence and adulthood, on the other, in two data sets. In the Christmas Seal Home Children Study the index cohort consisted of 3 020 subjects born in Finland in 1945–65 who were temporarily isolated from their family immediately after birth to nursing homes, the Christmas Seal Homes, due to tuberculosis in the family. The average separation time was seven months. For every index subject, two reference subjects were matched for sex, year of birth and place of birth. Data were obtained on schizophrenia from the Finnish Hospital Discharge Register (FHDR) in 1971–98 and on criminal offences from Statistics Finland in 1977–98. The 28-year cumulative incidence of schizophrenia was 1.6% both in the index cohort and in the reference cohort (RR 1.0; 95% CI 0.8–1.4). Both male and female index subjects had committed crimes more commonly than the reference subjects (in men RR 1.3; 95% CI 1.2–1.4; in women RR 1.5; 1.2–2.0). Of the male index subjects 12.1% as compared with only 7.1% of the reference cohort had committed violent offences (RR 1.7; 1.4–2.1). In the Northern Finland 1966 Birth Cohort mothers of 12 058 babies were asked at mid-gestation at the antenatal clinic if they felt depressed. This general population birth cohort of the children was followed up for 31 years being record-linked with the FHDR covering the years 1982–97 and with the criminal register of the Ministry of Justice up to 1998. We divided the schizophrenia patients into those having a psychotic first-degree relative (schizophrenia patients with familial risk for psychosis FR) and those without one. The cumulative incidence of hospital-treated schizophrenia was 1.3% among the offspring of depressed mothers and 0.9% among the descendants of non-depressed mothers (RR 1.5; 95% CI 0.9–2.4). The prevalence of antenatal depression was 35% in mothers of schizophrenia patients with FR. The respective prevalence was 14% both in the mothers of schizophrenia patients without FR and in the mothers of other cohort members. Both male and female offspring of antenatally depressed mothers were more commonly criminal offenders than offspring of non-depressed mothers (in men adjusted OR 1.5; 95% CI 1.2–1.9; in women OR 1.5; 0.8–3.0). In males, 6.5% with depressed mothers and 3.2% with non-depressed mothers had committed violent offences (adjusted OR 1.6; 1.1–2.4). Very early separation and mothers' depressed mood in pregnancy are per se unlikely to increase the risk for schizophrenia in the offspring, but seem to be connected to criminal behaviour, especially violent criminality in men
Tiivistelmä Raskaus- ja imeväisajan varhaiset tekijät on lisääntyvästi yhdistetty lapsen tuleviin mielenterveyshäiriöihin. Tarkoituksena oli tutkia hyvin varhaisen eron (separaation) ja äidin raskaudenaikaisen masentuneen mielialan yhteyttä lasten skitsofreniaan ja rikollisuuteen nuoruudessa ja aikuisuudessa kahdessa eri aineistossa. Joulumerkkikoti-lasten tutkimuksessa indeksikohortti koostui 1945–65 syntyneistä 3 020 tutkittavasta, jotka erotettiin väliaikaisesti perheistään heti syntymän jälkeen hoitokoteihin, Joulumerkkikoteihin, perheen tuberkuloosin takia. Ero vanhemmista kesti keskimäärin seitsemän kuukautta. Jokaiselle indeksitutkittavalle valittiin kaksi sukupuolen, syntymävuoden ja -paikan mukaan kaltaistettua verrokkitutkittavaa. Tieto skitsofreniaan sairastumisesta hankittiin sairaaloiden poistoilmoitusrekisteristä vv. 1971–98 ja rikoksista Tilastokeskuksesta 1977–98. 28 vuoden kumulatiivinen sairastuvuus skitsofreniaan oli 1,6 % sekä indeksi- että verrokkikohortilla (riskisuhde RR 1.0; 95 %:n luottamusväli CI 0,8–1,4). Sekä miehistä että naisista indeksitutkittavat olivat tehneet useammin rikoksia kuin vertailuryhmä (miehillä RR 1,3; 1,2–1,4; naisilla RR 1,5; 1,2–2,0). Miehistä 12,1 % indeksitutkittavista ja vain 7,1 % vertailuryhmästä oli tehnyt väkivaltarikoksen (RR 1,7; 1,4–2,1). Pohjois-Suomen 1966 syntymäkohortin 12 058 lapsen äideiltä kysyttiin keskiraskauden aikana äitiysneuvolassa, kokivatko he mielialansa masentuneeksi. Tämän väestötason syntymäkohortin (siis lasten) tietoja hankittiin 31-vuotisseurannassa sairaaloiden poistoilmoitusrekisteristä vuosilta 1982–97 ja oikeusministeriön rikosrekisteristä vuoteen 1998. Skitsofreniaan sairastuneet jaettiin niihin, joiden 1. asteen sukulainen oli ollut / ei ollut ollut psykoottinen. Sairaalahoitoa vaatineen skitsofrenian kumulatiivinen sairastuvuus oli 1,3 % masentuneiden ja 0,9 % masentumattomien äitien lapsilla (RR 1,5; 0,9–2,4). Raskaudenaikaisen masentuneen mielialan esiintyvyys oli 35 % niiden skitsofreniapotilaiden äideillä, joilla oli ollut lähisuvussa psykoosia. Vastaavasti masentunutta mielialaa esiintyi 14 %:lla sekä niiden skitsofrenia-potilaiden äideistä, joilla ei ollut sukurasitusta, että muiden kohorttitutkittavien äideistä. Sekä masentuneiden äitien pojista että tyttäristä useampi oli tehnyt rikoksen kuin masentumattomien äitien lapset (miehillä vakioitu vedonlyöntisuhde OR 1,5; 1,2–1,9; naisilla OR 1,5; 0,8–3,0). Masentuneiden äitien pojista 6,5 % ja masentumattomien äitien pojista 3,2 % oli tehnyt väkivaltarikoksen (vakioitu OR 1,6; 1,1–2,4). Hyvin varhainen ero ja äidin masentunut mieliala raskauden aikana eivät todennäköisesti sinänsä lisää skitsofrenian vaaraa lapsilla, mutta näyttävät olevan yhteydessä lasten rikolliseen käyttäytymiseen, erityisesti väkivaltarikoksiin miehillä

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
This research focus on the theme of the passionate follies, conceiving them under the angle of the feminine refusal in the maternal. Such questions are presented from the clinical history of Rosa and from the tale, O Homem da Areia, from E.T.A Hoffmann which, in their specificities present approximated logics. For explanation of the propositions of this paper, through the freudo-lacanian literature, tributary relations are established between the concepts of: maternal, focusing on the deadly face of an embodiment of pleasure; of Verleugnung in its relationship with the maternal belief; and feminine while a position in the sexual. Regard to this, the figure of an outline that encloses and includes a maternal body, is an aid for guiding assumptions of this study. The figures of the automaton and the mortified woman are presented as forms of passion. These seek to represent the unrepresentative, what is from the real field, in the case of this study, ways that utter an extreme passion. Conditions found in other passionate disorders in which there is a devastation of the subject, by tapping the irreducible field of language. In this direction, it is suggested a medical device called Fort-da literary, in which the subject can build and translate its conflict literally. This study draws the passionate follies as a psychopathology which points out to contemporary social issues. From the assumption that, in those psychopathological settings, there is a depletion of the narrative, indicating a discursive configuration similar to a contemporary narrative specificity
Esta pesquisa é dedicada ao tema das loucuras passionais, concebendo-as sob o ângulo da recusa do feminino no materno. Tais questões são apresentadas a partir da história clínica de Rosa e o do conto, O Homem da Areia, de E.T.A. Hoffmann que, em suas especificidades, apresentam lógicas aproximadas. Para fundamentação das proposições deste trabalho, através da literatura freudo-lacaniana, estabelecem-se relações tributárias entre os conceitos de: materno, enfocando a face mortífera de uma corporeidade de gozo; de Verleugnung na sua relação com a crença materna; e de feminino enquanto uma posição no sexual. Neste, a figura de um contorno que circunscreve e contém um corpo materno, é um subsídio para os pressupostos norteadores deste estudo. As figuras do autômato e da mulher mortificada são apresentadas como formas de figuras da paixão. Estas buscam representar o irrepresentável, o que é do campo do real, no caso deste estudo, formas que absolutizam uma extrema passionalidade. Condições encontradas em estados de perturbações passionais, e nas quais há uma devastação do sujeito, tocando no campo do irredutível da linguagem. Nessa direção, sugere-se um dispositivo clínico, denominado Fort-da literário, em que o sujeito possa construir e traduzir seu conflito literariamente. Deste estudo se extrai a indicação de loucuras passionais como uma psicopatologia que sinaliza questões do laço social contemporâneo. A partir do pressuposto de que, naquelas configurações psicopatológicas, há um empobrecimento da narrativa, indica-se uma configuração discursiva similar a uma especificidade narrativa contemporânea

Background: As overnutrition rises along with nutrition transition in low- and middle-income settings such as Bangladesh, evaluating metabolic risk factors using overnutrition measures in adolescents is important. Before doing such evaluation, a preliminary step should be taken to attest the independence of overnutrition measures from total height. Moreover, sitting height measures are recognized as important metabolic risk indicators. This study aims to understand the association of attained height –total and sitting– with overnutrition measures including body mass index (BMI), percent body fat (PBF), fat mass index (FMI) and fat free mass index (FFMI) and to assess modification by sex. Methods: Cross-sectional analysis of the MINIMat study’s 15-year follow-up data from October 2017 to December 2018 was undertaken. The associations of attained height –total and sitting– with each of the overnutrition measures were analysed using multiple linear regressions. Results: Overnutrition measures were non-independent of total height among male adolescents. The taller they were, the higher their BMI would be. This increase of BMI along with the height would have been contributed relatively more by the increase of fat free mass (FFM) than that of fat mass (FM). When total heights of both sexes were kept equal at the median, female adolescents had lower lean mass (FFMI) and higher fat mass (FMI) than the males although there was no difference in BMI on average between them. Sitting height was associated with all overnutrition measures with varying extents depending on the sex. Conclusion: When assessing overnutrition measures, it is important to examine beyond BMI and into FMI and FFMI. Again, when assessing the metabolic risks using overnutrition measures among adolescents, normalizing those indices for height is important to be considered to avoid inferring the implication from growth as risks.

Having a newborn can be a big change for families, especially for first-time parents. At hospital discharge, parents are often provided with a lot of information, which can be difficult to retain. Due to shortened postnatal lengths of stay, nurses typically have less time to educate parents, which often results in families feeling overwhelmed. After hospital discharge, it is recommended for families to see a health care provider (i.e., physician, nurse practitioner, or registered midwife) within 72 hours for a follow-up appointment. This follow-up appointment is meant to assess both the mother and newborn to ensure they are both in good health and to provide any needed support. Unfortunately, completing the appointment within this timeframe may not be possible for every family or they may not be aware of its importance. Depending on the family’s model of care, completing the follow-up appointment within 72 hours after hospital discharge can be challenging. Families that have a physician as their health care provider may experience delays in scheduling the follow-up appointment. This can be due to the physician’s lack of availability, as there is a physician shortage in most communities. Furthermore, some families do not have access to a health care provider and, therefore, do not see a care provider after hospital discharge. Completing the follow-up appointment later than when it is recommended, or not at all, can result in negative health consequences for the mother and newborn and can also increase re-admission hospital rates and related costs (Cargill et al., 2007). At the moment, postnatal lengths of stay are shortening but the service delivery has not changed to accommodate this trend (Lemyre et al., 2018). This means that the services typically provided to families in the hospital now need to be provided in the community. The follow-up appointment after hospital discharge is an opportunity to provide these services; however, timely access to a health care provider, specifically a physician, can be challenging. Thus, this thesis explores the development of a general design methodology for a postpartum nurse practitioner-led clinic. The aim of the clinic is to provide timely access to any family that needs to complete the necessary postpartum services after hospital discharge within a community. An analytical model was developed to explore the characteristics of a postpartum nurse practitioner-led clinic and how it would operate (i.e., what services would be offered, the amount of time needed for these services, what is needed to offer these services, etc.). The model conducts a simulation of the appointment scheduling process based on the input values entered into it and evaluates a number of performance metrics (e.g., number of diversions, patient wait times, resource idle time, clinic overtime, number of appointments provided within 72 hours and number of appointments provided beyond 72 hours). The findings from the model can support the potential implementation of a postpartum nurse practitioner-led clinic in any community. Implementing such clinics could increase awareness, further educate parents and increase access to postpartum services.

Estudou-se prospectivamente o comportamento das calcificações, da atrofia, das alterações da substância branca e alterações vasculares nas imagens de tomografia computadorizada de crânio de 162 crianças e adolescentes infectados pelo vírus da imunodeficiência humana (HIV) por transmissão vertical e que estavam ou estiveram em acompanhamento clínico no Ambulatório de Infectologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 1992 e 2002. Analisaram-se as possíveis correlações entre estas alterações e seu aspecto evolutivo. Para tal finalidade, foram avaliadas 606 tomografias computadorizadas de crânio (média de 3,74 exames por paciente), as quais constituíram o grupo de estudo. Após a caracterização quanto à presença ou não das alterações supracitadas, e suas possíveis inter-relações, realizou-se a análise estatística dos resultados obtidos através do teste exato de Fisher com nível de significância de 5%. Posteriormente, os mesmo aspectos foram avaliados em função do seu comportamento evolutivo em um subgrupo de 61 pacientes (média, 4,18 exames por paciente, totalizando 321 exames tomográficos). Estes pacientes tinham, pelo menos, quatro estudos tomográficos seriados (com intervalo mínimo de noventa dias entre os exames subseqüentes e pelo menos dois anos de intervalo total entre o primeiro e o último exame). As alterações tomográficas foram abordadas individual e qualitativamente segundo o critério de presença e intensidade. Inicialmente, o conjunto dos resultados foi tratado de forma individual (para cada paciente) e, depois, em relação à totalidade do grupo em questão. As calcificações foram encontradas em 46,30% dos pacientes; a atrofia, em 37,65%; as alterações da substância branca, em 25,93%; as anomalias vasculares, em 25,19%. Constatou-se uma correlação significativa entre as alterações de substância branca e a atrofia, bem como entre as calcificações e as alterações vasculares. A análise evolutiva destas características demonstrou haver um acréscimo significativo das alterações entre o momento inicial e o quarto momento no conjunto das alterações, sobretudo para as calcificações e para as alterações vasculares. Concluiu-se que as calcificações e a atrofia foram as alterações mais freqüentes nesta série de crianças e adolescentes com HIV adquirido por transmissão vertical. A atrofia e as alterações da substância branca apresentaram uma inter-relação importante na amostra descritiva, assim como as alterações vasculares e as calcificações mostraram uma associação evolutiva significativa em relação à sua progressão
We prospectively studied the behavior of calcifications, atrophy, white matter and vascular abnormalities on the images of computed tomography (CT) of 162 children and adolescents infected with the human immunodeficiency virus (HIV) acquired by vertical transmission, who are or were clinically followed in the Ambulatory of Pediatric Infectology of the Children Institute at the Clinics Hospital of University of São Paulo Medical School, from 1992 to 2002. We analyzed the possible correlation between these abnormalities, as well as, their evolutive aspects. For this purpose, we evaluated 606 CT scans (mean 3.74 exams per patient), which composed the group of study. After the characterization according to the presence or not of the anomalies mentioned above, and their possible inter-relations, we performed a statistical analysis of the obtained results with the Fisher test with a level of significance below 5%. Later, these aspects were evaluated regarding its evolutive behavior in a subgroup of 61 patients (mean, 4.18 exams per patient, summing 321 exams). These patients had, at least, four serial cranial CT (with minimum interval of ninety days between the subsequent exams and, at least, two years of total interval between the first and the fourth exam). The cranial CT abnormalities presented were assessed individually as absent or present. Initially, the set results were assessed individually (for each patient) and, later in relation to the totality of the group. Calcifications were found in 46.30% of all patients, atrophy in 37.65%, white matter abnormalities in 25.93% and vascular anomalies in 25.19%. We found a significant correlation between white matter abnormalities and atrophy, as well as, between calcifications and vascular anomalies. Evolutive analysis of these characteristics demonstrated a significant increase of the abnormalities between the first and the fourth moment, with emphasis to the calcifications and vascular anomalies. We concluded that, calcifications and atrophy were the most frequent abnormalities in this series of children and adolescents with HIV acquired by vertical transmission. Atrophy and white matter abnormalities presented a significant correlation in the descriptive sample, as well as, vascular anomalies and calcifications that also demonstrated a significant evolutive association regarding its progression

Die vorliegende Arbeit widmet sich der Aufgabe makroskopische Berechnungsmodelle zur Beschreibung des Drahtsägens zu erarbeiten. Ziel ist es, die wesentlichen Effekte abzubilden und den Einfluss von Prozessparametern auf die Dynamik des Systems zu bestimmen. Ein zentraler Punkt ist die Modellierung des bewegten Sägedrahtes. Durch die dem Kontinuum an den Auflagern aufgeprägte Führungsbewegung sind einerseits die Randbedingungen und andererseits ortsfest auf den Draht wirkende Lasten nichtmateriell. Die korrekte kinematische Beschreibung dieses Sachverhaltes ist essentielle Grundlage für die spätere Anwendung des Prinzips von HAMILTON. Durch die Führungsbewegung, die Formulierung der Kontaktkräfte als Folgelasten und durch explizit zeitabhängige Systemparameter ergibt sich ein kompliziertes Systemverhalten. Die dargestellten Berechnungsergebnisse umfassen Studien zu stationären Lagen, die Berechnung von Eigenfrequenzen, Stabilitätsnachweise des dynamischen Grundzustandes, die Bestimmung von Zeitlösungen und die Simulation des Materialabtrages beim Einschnitt
The aim of the present thesis is to generate macroscopic models to describe the wire sawing process. The principal purpose is to illustrate basic effects and to investigate the influence of important process parameters relating to the dynamics of the system. A fundamental point is the modeling of the moving wire. Because of the axially movement of the continuum the boundary conditions and spatial acting loads are non-material. The precise kinematical description of this issue is the pre-condition for the correct evaluation of HAMILTON’s principle to characterize the dynamics of the system. The resultant complex system behavior is a consequence of the movement of the wire, of the formulation of the contact forces as follower loads and of explicitly time-dependent model parameters. The results of research contain studies of steady state equilibrium solutions and the proof of their LJAPUNOW stability, the calculation of eigenfrequencies, steady state time solutions under harmonically oscillating contact forces and the simulation of the material removal during the cutting process

World regions are becoming more connected by every day and as a consequence of that dependence rises among states. The states become specialised in production of certain type of the product, services etc. Subsequently they turn to be even more dependent. One does not need to go further back then real-estate crisis in USA that spilled over worldwide. The world is turn out to be "smaller place". America and Europe are exploiting raw material less and less and become dependant on the import of those from around the world. Former exploitation and production became ballast to the environment [environment burdens]. One day factories and mines were closed or reorganised to different production activity and doing so reduced burden to the environment. The consumption of the product remained or was increased even more. In other words, some one else is producing that product. The production shifted among states moving the environment burdens with it. The aim of this document is to provide an overview of impacts relevant to the use of metals zinc, aluminium, nickel, iron and tin; quantification of physical import and export and calculation of international trade balance of before mentioned metals and analysis of six ores. Those aims are supposed to assist us on answering questions to which extent Czech...

Attendance at Neonatal Follow-up (NFU) programs is crucial for parents to gain access to timely diagnostic expertise, psychosocial support, and referral to needed services for their infants. Although NFU programs are considered beneficial, up to 50% of parents do not attend these programs with their infants. Non-attending infants have poorer outcomes (e.g., higher rates of disabilities and less access to required services) as compared to attenders. The purpose was to determine factors that predicted attendance at NFU. Naturally occurring attendance was monitored and maternal-infant factors including predisposing, enabling, and needs factors were investigated, guided by the Socio-Behavioral Model of Health Services Use. A prospective two-phase multi-site descriptive cohort study was conducted in 3 Canadian Neonatal Intensive Care Units that refer to 2 NFU programs. In Phase 1, standardized questionnaires were completed by 357 mothers (66% response rate) prior to their infant’s (N= 400 infants) NICU discharge. In Phase 2, attendance patterns at NFU were followed for 12 months. Higher maternal stress at the time of the infant’s NICU hospitalization was predictive of attendance at NFU. Parenting alone, more worry about maternal alcohol or drug use, and greater distance to NFU were predictive of non-attendance at NFU. Attendance at NFU decreased over time from 84% at the first appointment to 74% by 12 months. Two distinct attendance patterns emerged: no or minimal attendance (18.5%) and attendance at all or the majority of scheduled appointments (81.5%). The most frequent point of withdrawal from NFU occurred between NICU discharge and the first scheduled appointment; followed by drop-out following the first NFU appointment. These results provide new insight into patterns of attendance and the maternal-infant factors that characterize attenders/non-attenders at NFU and serve as the critical first step in developing interventions targeted at improving attendance, infant outcomes, and reporting of developmental sequelae.

碩士
國立成功大學
行為醫學研究所
96
The aim of the present study was to examine whether maternal parenting (supervision, inconsistent discipline) mediated the relationship between infant’s distress to limits at 4 months (T1) and their disruptive behavior problems at age 6 (T2). A total of 130 mother-offspring dyads were recruited in the final sample of this longitudinal study. Mothers completed the measures of child’s distress to limits (IBQ) at T1, maternal parenting (PAS), and the disruptive behavior problems of children (CBECL/4-16) at T2. Results from path analysis indicated that child’s distress to limits significantly predicted disruptive behaviors mediated through maternal inconsistent discipline, but not maternal supervision. Higher distress to limits would lead to the increase in maternal inconsistent discipline, and resulted in more disruptive behavior problems of the children. The results also showed that maternal supervision would directly affect child’s disruptive behaviors; increase in maternal supervision would reduce child’s disruptive behaviors. Limitations should be noted in the need for a more conscientious longitudinal design and multiple measurements should be taken into account in future research.

碩士
國立成功大學
行為醫學研究所
98
Background: The relation between depression and anxiety symptoms during postpartum and infant difficult temperament has been well-documented in past studies. Recent studies highlight that maternal trait anxiety symptoms during pregnancy also contribute independently to infant difficult temperament. Furthermore, prenatal stress may have an indirect effect on infant difficult temperament, which may be mediated through depression/anxiety during postpartum. Aims: To examine whether the maternal fearfulness directly and/or indirectly contributes to different dimensions of infant’s temperament through prenatal anxiety and postpartum depression symptoms after controlling for possible confounders. Method: In an obstetrics and gynecology clinic of a public hospital in Taiwan, 512 pregnant women were recruited for study at four time points (36th week of pregnancy, 1st day, 8th week and 4th month in postpartum). The Symptom Checklist-90 revised was administered during pregnancy at 36 weeks of gestation and at 8 weeks postpartum. The EAS Temperament Survey for Adults and Infant Behavior Questionnaire was completed by 213 mothers (mean age = 29.1 years) at 4 months postpartum. Results: Hierarchical regression analyses showed that (1) maternal fearfulness was associated with infant activity level and was mediated through postpartum depression; (2) postpartum depression made an independent contribution to the distress to limitations scale; and that (3) Maternal fearfulness, prenatal anxiety and postpartum depression could not significantly predict infant distress to novelty. Discussion/Conclusion: Maternal fearfulness and depressive symptoms during pregnancy and postpartum appear to contribute to infant temperament differentially.

博士
國立中正大學
心理學所
97
Two major purposes of the present research was, first, to follow up fifty-four mother-toddlers dyads in two types of new immigrant families, i.e. mothers from Mainland China and Southeastern Asia, as well as in the local families, and the second, to investigate the relationship between maternal parenting behaviors and young children’s responses toward mother’s demands. The research procedures were conducted when toddlers were at 16- and 22-months old. In a free play session, the frequencies of maternal parenting behaviors such as praising the child, repeating children’s verbal responses, questioning, naming objects, threatening, and physical interruptions were videotaped and coded. In addition, mother-toddler eye gazes and joint-attentional behaviors were also measured. In a clean-up session, children’s responses of completing task independently, with mothers’ assistance, with neglect, with avoidance, or with refusal behaviors toward mothers’ demands were measured. Familial SES and mothers’ age were served as family variables. The covariate analysis was conducted to control family SES and the mother’s age. Results found a main effect of mothers’ naming objects behaviors were less in mothers from Mainland China and Southeastern than those of local mothers. The significant interaction effect and its follow-up analysis suggested that at 16 months, less naming objects were found in those mothers from Mainland China and Southeastern Asia than those local mothers. The mother-toddler joint-attentional behaviors of mothers from Mainland China and Southeastern Asia were both less than those with Taiwanese mothers. With increased age, children increased their frequencies in independent completion of the task, and their needs in mothers’ assistance decreased. The results of hierarchical regression analysis with family background (step 1) and mothers’ parenting behavior (step 2) suggested mothers’ parenting behavior predicted children’s independent completion behaviors at 16 months, that maternal threatening behavior predicted children’s independent completion behaviors. The results of hierarchical regression analysis with family background (step 1), children’s responses at 16 months (step 2), and mothers’ parenting behavior (step 3) suggested children’s independent completion behaviors at 16 months predicted children’s responses at 22 months when eliminating the effects of variables of family background. Furthermore, with control of both family background and children’s responses at 16 months, mothers’ parenting behavior predicted the changes between children’s responses at 16 to 22 months. The results suggested that maternal repetition of children’s verbal behaviors predicted the change of children’s independent completion between 16 and 22 months of age. On the other hand, children’s behaviors at 16 months predicted children’s neglected and defiant responses at 22 months when eliminating the effects of variables of family background. The results suggested those children’s neglect and refusal behaviors predicted children’s neglected and defiant behaviors at 22 months of old. In conclusion, mothers’ verbal parenting behaviors and mother-toddler joint-attentional behaviors were significantly different between new immigrant mothers and those of local mothers during early childhood. Mothers’ repetition of children’s verbal behaviors promoted the children’s independent completion behaviors.

Thesis objectives: The thesis deals with the comparison of wound healing management in acute and subsequent care. The theoretical part presents the knowledge of acute and chronic wounds, wound healing and their phases. Furthermore, the thesis deals with methods of wound treatment. The last chapter of the theoretical part deals with management and the role of a nurse in caring for a patient with a wound. In the empirical part, the first goal was to find out whether nurses from the Hradec Králové Region hospitals know the division and types of wounds. The second goal was to map out the possibilities for nurses to heal wounds. Another aim was to compare the differences between wound healing in acute and subsequent care. The fourth goal mapped the knowledge of nurses about wound healing materials. The following aim was to find out which materials for wound care are available at the hospital of the Hradec Králové Region. The sixth goal was to compare the economic and time-consuming wound healing at the acute and aftercare departments. The last goal of the thesis is to elaborate a seminar within the framework of lifelong education of general nurses on the topic of effective wound healing. Five hypotheses and two research questions were formulated to meet the goals of the thesis. Method for achieving the objectives: The set goals were achieved through quantitative questionnaire research and qualitative observation and interview research, which were chosen to complement the results. The sample included general nurses working in the internal department, the surgical department, the intensive care unit, the anesthesiology-resuscitation department and the aftercare departments in the hospitals of the Hradec Králové region. The total number of respondents was 120. Scientific benefits of the thesis: Overall research shows that nurses have sufficient knowledge of wounds and their treatment, but deficiencies in some areas are still evident. Furthermore, the research shows that nurses do not have enough therapeutic material to work on their workplaces. The interviewed group of general nurses said they think that modern dressing materials have a positive effect on wound healing. The results of the work can be used for practice, in hospital and other health care facilities to improve wound healing. The findings and conclusions: In the tracked file, we verified that the length of treatment of wounds on beds of acute and subsequent care differs (p = 0.002); the results show that the average time of wound dressing is prolonged in subsequent care. Conversely, the availability of dressing materials in the respective departments did not differ (p = 0.159). Furthermore, we found that the economic intensity of the after-care beds is lower, despite the fact that more wound dressings are done than in the acute care.

碩士
長庚大學
護理學研究所
97
The purposes of this study were to 1) examine the parental uncertainty, parenting distress, coping behaviors and quality of life when mothers had a child who was newly diagnosed as cancer and the change at 3 months follow up, 2) examine predictors of quality of life for mothers. Data were collected from mothers whose child had newly diagnosed as a cancer (hereafter baseline) and the same data were collected again at 3 month follow up (hereafter 3-month follow up). At the baseline data, 135 mothers were participated in the study. Only 95 mothers completed the 3 month follow up assessment. The findings shown that mothers reported statistically higher scores in the subscale of "Uncertainty-child illness", "Uncertainty-parenting and disease diagnosis" at baseline assessment than the 3-month follow up (P <0.01). There was no differences found for parental distress between baseline and 3-month follow up assessment. For coping strategies used by mothers, mothers at baseline assessment tended to use more “emotional-focus” coping strategies than 3-month follow up (p <0.01). Mothers also reported that better physical quality of life at 3-months follow up than the baseline assessment (p <0.05). In order to examine the predictors of quality of life for mothers, analysis were conducted for“physical”and“mental”quality of life. For“physical”quality of life, only parental distress was statistically significant with“physical”quality of life . For“mental”quality of life, parental distress, social support strategies and uncertainty were the predictors (p <0.05).

Die vorliegende Arbeit widmet sich der Aufgabe makroskopische Berechnungsmodelle zur Beschreibung des Drahtsägens zu erarbeiten. Ziel ist es, die wesentlichen Effekte abzubilden und den Einfluss von Prozessparametern auf die Dynamik des Systems zu bestimmen. Ein zentraler Punkt ist die Modellierung des bewegten Sägedrahtes. Durch die dem Kontinuum an den Auflagern aufgeprägte Führungsbewegung sind einerseits die Randbedingungen und andererseits ortsfest auf den Draht wirkende Lasten nichtmateriell. Die korrekte kinematische Beschreibung dieses Sachverhaltes ist essentielle Grundlage für die spätere Anwendung des Prinzips von HAMILTON. Durch die Führungsbewegung, die Formulierung der Kontaktkräfte als Folgelasten und durch explizit zeitabhängige Systemparameter ergibt sich ein kompliziertes Systemverhalten. Die dargestellten Berechnungsergebnisse umfassen Studien zu stationären Lagen, die Berechnung von Eigenfrequenzen, Stabilitätsnachweise des dynamischen Grundzustandes, die Bestimmung von Zeitlösungen und die Simulation des Materialabtrages beim Einschnitt.:1 Einleitung 1.1 Technische Problemstellung und Motivation der Arbeit 1.2 Literaturübersicht 1.3 Thema und Gliederung der Arbeit 2 Theoretische Grundlagen 2.1 Notation und mathematische Grundlagen 2.2 Kinematische Grundlagen der Kontinuumsmechanik 2.2.1 Konfiguration und Betrachtungsweisen 2.2.2 Verformungskinematik 2.2.3 Zeitableitungen 2.3 Variationsrechnung 2.3.1 Grundlagen 2.3.2 Verallgemeinerte Variationen 2.4 Kinetik / Prinzip von HAMILTON 2.5 Diskretisierung von Feldproblemen 2.6 Stabilität stationärer Lösungen 2.6.1 Grundlagen der kinetischen Stabilitätstheorie 2.6.2 Erste Methode von LJAPUNOW 2.6.3 Stabilitätsbetrachtung für bewegte Kontinua 2.7 Zeitlösung 2.7.1 Homogene Lösung der Störungsdifferentialgleichungen 2.7.2 Partikuläre Lösung der Störungsdifferentialgleichungen 3 Mechanisches Modell und Modellvarianten 3.1 Kinematik des Drahtes in LAGRANGE-Koordinaten 3.2 Kinematik des Drahtes in EULER-Koordinaten 3.3 Modell I 3.3.1 Variationsformulierung und Feldgleichungen 3.3.2 Ortsdiskretisierung der Variationsformulierung 3.3.3 Stationäre Lage, Stabilitätsuntersuchung und Zeitlösung 3.4 Modell II 3.4.1 Variationsformulierung und Feldgleichungen 3.4.2 Ortsdiskretisierung der Variationsformulierung 3.4.3 Stationäre Lage, Stabilitätsuntersuchung und Zeitlösung 3.5 Numerische Umsetzung 3.6 Berechnungsergebnisse 3.6.1 Stationäre Lagen 3.6.2 Eigenfrequenzen 3.6.3 Stabilitätsuntersuchungen 3.6.4 Zeitlösungen 4 Ankopplung des Ingot und Modellierung des Materialabtrages 4.1 FE- Modell des Gesamtblocks 4.1.1 Bestimmung der mechanischen Eigenschaften des Ingot 4.1.2 Berechnungsergebnisse 4.2 Strukturmechanisches Modell des Gesamtblocks und Ankopplung an den Sägedraht 4.3 Variationsformulierungen der gekoppelten Gesamtsysteme unter Berücksichtigung des Materialabtrages 4.3.1 Gesamtmodell I 4.3.2 Gesamtmodell II 4.4 Simulation des Schnittvorganges 5 Zusammenfassung / Ausblick 6 Verzeichnisse 6.1 Literaturverzeichnis 6.1.1 Allgemeine Literatur 6.1.2 Literatur zum Thema Drahtsägen 6.1.3 Literatur zum Thema bewegte Kontinua Anhang
The aim of the present thesis is to generate macroscopic models to describe the wire sawing process. The principal purpose is to illustrate basic effects and to investigate the influence of important process parameters relating to the dynamics of the system. A fundamental point is the modeling of the moving wire. Because of the axially movement of the continuum the boundary conditions and spatial acting loads are non-material. The precise kinematical description of this issue is the pre-condition for the correct evaluation of HAMILTON’s principle to characterize the dynamics of the system. The resultant complex system behavior is a consequence of the movement of the wire, of the formulation of the contact forces as follower loads and of explicitly time-dependent model parameters. The results of research contain studies of steady state equilibrium solutions and the proof of their LJAPUNOW stability, the calculation of eigenfrequencies, steady state time solutions under harmonically oscillating contact forces and the simulation of the material removal during the cutting process.:1 Einleitung 1.1 Technische Problemstellung und Motivation der Arbeit 1.2 Literaturübersicht 1.3 Thema und Gliederung der Arbeit 2 Theoretische Grundlagen 2.1 Notation und mathematische Grundlagen 2.2 Kinematische Grundlagen der Kontinuumsmechanik 2.2.1 Konfiguration und Betrachtungsweisen 2.2.2 Verformungskinematik 2.2.3 Zeitableitungen 2.3 Variationsrechnung 2.3.1 Grundlagen 2.3.2 Verallgemeinerte Variationen 2.4 Kinetik / Prinzip von HAMILTON 2.5 Diskretisierung von Feldproblemen 2.6 Stabilität stationärer Lösungen 2.6.1 Grundlagen der kinetischen Stabilitätstheorie 2.6.2 Erste Methode von LJAPUNOW 2.6.3 Stabilitätsbetrachtung für bewegte Kontinua 2.7 Zeitlösung 2.7.1 Homogene Lösung der Störungsdifferentialgleichungen 2.7.2 Partikuläre Lösung der Störungsdifferentialgleichungen 3 Mechanisches Modell und Modellvarianten 3.1 Kinematik des Drahtes in LAGRANGE-Koordinaten 3.2 Kinematik des Drahtes in EULER-Koordinaten 3.3 Modell I 3.3.1 Variationsformulierung und Feldgleichungen 3.3.2 Ortsdiskretisierung der Variationsformulierung 3.3.3 Stationäre Lage, Stabilitätsuntersuchung und Zeitlösung 3.4 Modell II 3.4.1 Variationsformulierung und Feldgleichungen 3.4.2 Ortsdiskretisierung der Variationsformulierung 3.4.3 Stationäre Lage, Stabilitätsuntersuchung und Zeitlösung 3.5 Numerische Umsetzung 3.6 Berechnungsergebnisse 3.6.1 Stationäre Lagen 3.6.2 Eigenfrequenzen 3.6.3 Stabilitätsuntersuchungen 3.6.4 Zeitlösungen 4 Ankopplung des Ingot und Modellierung des Materialabtrages 4.1 FE- Modell des Gesamtblocks 4.1.1 Bestimmung der mechanischen Eigenschaften des Ingot 4.1.2 Berechnungsergebnisse 4.2 Strukturmechanisches Modell des Gesamtblocks und Ankopplung an den Sägedraht 4.3 Variationsformulierungen der gekoppelten Gesamtsysteme unter Berücksichtigung des Materialabtrages 4.3.1 Gesamtmodell I 4.3.2 Gesamtmodell II 4.4 Simulation des Schnittvorganges 5 Zusammenfassung / Ausblick 6 Verzeichnisse 6.1 Literaturverzeichnis 6.1.1 Allgemeine Literatur 6.1.2 Literatur zum Thema Drahtsägen 6.1.3 Literatur zum Thema bewegte Kontinua Anhang

BACKGROUND: Many women of reproductive age are employed in industries involving exposure to organic solvents. Animal toxicological studies and human case reports demonstrate that exposure to organic solvents can cause neuropsychological deficits in exposed offspring; however, there is limited data from prospective controlled human studies. OBJECTIVE: To compare neuropsychological functioning between children whose mothers were occupationally exposed to organic solvents during pregnancy with a non-exposed matched comparison group. METHODS: Participants were 48 women who had previously contacted the Motherisk Program in Toronto, Canada during pregnancy regarding occupational exposure to organic solvents and a matched comparison group of women with no known exposure to teratogens during pregnancy. Children (18 months to 8 years 11 months at time of study) were compared in areas of cognitive, language, motor, and behavioral functioning. RESULTS: Children whose mothers were exposed to organic solvents during pregnancy displayed a lower level of functioning when compared with their matched peers in areas of cognitive, language, motor, and behavioral domains. Although the scores on measures of behavioral functioning were not in the clinical range, the mothers of exposed children reported more challenging behavioral problems. In order to determine whether exposure predicted neuropsychological outcomes above and beyond maternal intellectual functioning, hierarchical regressions were run with maternal IQ and maternal education at Step 1and exposure status added at Step 2. In utero exposure to organic solvents predicted lower sores on global measures of Verbal IQ, receptive and expressive language scales above and beyond maternal intellectual functioning. Factors associated with higher levels of exposure (detecting odor, longer duration and total number of toxicity symptoms) was associated with poorer outcome on behavioral and motor functioning tests. CONCLUSION: Despite the fact that the exposed mothers experienced minimal symptoms of toxicity, detrimental effects were still evident in their offspring. Current safety standards for exposure were designed for adults and need to be reevaluated. Further studies addressing exposure to specific organic solvents, dose, and gestational timing of exposure are warranted.