Bakgrund: SFOG har tillsammans med SBF, SNS och LÖF upprättat riktlinjer för förlossningsvården som bland annat berör dokumentation av CTG. Dessa har tagits fram genom ”Projekt säker förlossningsvård” och antagits av Blekingesjukhuset Karlskrona år 2008. Syfte: Syftet var att undersöka barnmorskors och läkares följsamhet av CTG-dokumentation, vid aktivt förlossningsförlopp, i förhållande till lokala PM, aktuella riktlinjer och nationella styrdokument på förlossningsavdelningen, Karlskrona. Metod: Retrospektiv journalgranskningmed deskriptiv design har använts.  Datainsamling omfattar tidsperioden 2011-07-01 t.o.m. 2012-03-04. Totalt ingick 748 journaler och 1547 dokumentationer i studien. Dataanalys har skett med hjälp av statistikprogrammet SPSS. Resultat: Av journalerna hade 22% ingen dokumentation om CTG och 46% av dokumentationerna innehöll en klassifikation. Åtgärd har dokumenterats i 80% och dokumentationerna var skriven utan förkortning i 45%. Följsamheten av klassificering och åtgärd tillsammans var totalt 44%medan barnmorskors var 38% och läkares 8%. Konklusion: Följsamheten av CTG-dokumentationbehöver förbättras på förlossningsavdelningen i Karlskrona. Majoriteten av vad som dokumenteras följer inte PM, riktlinjer och nationella styrdokument. / Background: SFOG, SBF, SNS and LÖF have conducted guidelines for obstetric care including documentation of CTG. These have been developed during “Projekt säker förlossningsvård” and adopted 2008 by the hospital in Blekinge, Karlskrona. Aim: The aim of this study was to examine the compliance of CTG documentation by midwives and physician, during active labor, in relation to local PM, current guidelines and national policy at the labor ward Karlskrona. Method: Retrospective study using descriptive design was used. Data collection covers the time period 2011-07-01 to 2012-03-04. Totally 748 records and 1547 documentations were reviewed. Data analysis was progressed in SPSS. Result: Of the total records, 22% did not have any documentation about CTG and 46% of the collected documentations had a classification. Action was documented in 80%, and the documentations were written without an abbreviation in 45%. Compliance of classification and action together was 44%, midwives had  38% and physicians 8%. Conclusion: The compliance of CTG documentation needs improvement in the labor ward in Karlskrona. The majority of documents are not followed by PM, guidelines and national policy documents.

Submitted by FERNANDA DA SILVA VON PORSTER (fdsvporster@univates.br) on 2014-10-02T17:32:07Z No. of bitstreams: 3 license_text: 22790 bytes, checksum: 5583a4be1f6dbb777e1501f0e06a0664 (MD5) license_rdf: 23748 bytes, checksum: b92763cfc0af52c7c868455edfaf3266 (MD5) 2013SilvanaAparecidaMendesMatsdorff.pdf: 1306731 bytes, checksum: 69096a58f93330b12932c84a7b7e229c (MD5) / Approved for entry into archive by Ana Paula Lisboa Monteiro (monteiro@univates.br) on 2014-10-08T13:41:56Z (GMT) No. of bitstreams: 3 license_text: 22790 bytes, checksum: 5583a4be1f6dbb777e1501f0e06a0664 (MD5) license_rdf: 23748 bytes, checksum: b92763cfc0af52c7c868455edfaf3266 (MD5) 2013SilvanaAparecidaMendesMatsdorff.pdf: 1306731 bytes, checksum: 69096a58f93330b12932c84a7b7e229c (MD5) / Made available in DSpace on 2014-10-08T13:41:56Z (GMT). No. of bitstreams: 3 license_text: 22790 bytes, checksum: 5583a4be1f6dbb777e1501f0e06a0664 (MD5) license_rdf: 23748 bytes, checksum: b92763cfc0af52c7c868455edfaf3266 (MD5) 2013SilvanaAparecidaMendesMatsdorff.pdf: 1306731 bytes, checksum: 69096a58f93330b12932c84a7b7e229c (MD5) / A qualidade de vida é uma compreensão pessoal, de como o indivíduo percebe o mundo e a si próprio. Diz respeito ao bem-estar físico, psicológico e social do ser humano e tem relação com sua cultura, com seus valores, condição econômica, expectativas de vida, relação com o ambiente e políticas públicas. O presente estudo visou identificar a qualidade de vida de participantes de uma comunidade de sentidos denominada Centro de Tradições Gaúchas (CTG) Nova Querência, localizado no município de Boa Vista/RR, bem como suas percepções sobre a contribuição desse ambiente para a promoção de sua qualidade de vida. A pesquisa qualiquantitativa de corte transversal ocorreu no período de outubro a novembro de 2012. Os participantes que tinham frequência mínima de três vezes ao mês no Centro foram convidados a fazer parte da pesquisa, sendo que 59 pessoas participaram por adesão. Foi utilizando o instrumento de avaliação World Health Organization Quality of Life (WHOQOL-Bref) da Organização Mundial de Saúde (OMS) para analisar as respostas referentes à qualidade de vida nos domínios: físico, psicológico, ambiental e das relações sociais dos maiores de 18 anos e entrevistas e grupos focais com pessoas de diferentes faixas etárias para identificar as suas percepções sobre a influência do Centro em sua qualidade de vida. As médias das respostas dos participantes do CTG para o instrumento WHOQOL-Bref apontaram para uma boa qualidade de vida em todos os domínios analisados, sendo que o maior escore encontra-se no domínio social e o menor, no domínio físico, com as seguintes médias: Domínio físico: 63,47 ±1,55; Domínio psicológico: 69,81 ±1,44; Domínio social: 79,08 ±2,03 e Domínio ambiental: 69,25 ±1,88. A relevância das relações sociais para a qualidade de vida dos participantes do estudo foi observada também nas análises de seus relatos.

Parmi les espèces de levures du clade CTG, certaines sont responsables de candidoses tandis que d’autres présentent des potentiels en biotechnologie. Depuis quelques années, nous assistons à une intensification des recherches sur ces levures. Cependant, leur code génétique particulier a ralenti la mise au point d’outils génétiques pour la plupart d’entre elles. Cette thèse vise à développer des outils moléculaires standardisés pour un grand nombre d’espèces de levures du clade CTG. Nous avons d’abord conçu des vecteurs d’expression adaptés à l’espèce M. guilliermondii. Par la suite, nous avons caractérisé le gène de résistance à l’acide mycophénolique IMH3.2 afin de l’utiliser comme marqueur de sélection lors de la transgénèse d’espèces du clade CTG. Enfin, nous avons mis au point une série de vecteurs permettant la manipulation génétique de ces espèces. Ce travail a conduit à la conception d’une large gamme d’outils utilisable dans un grand nombre de ces levures, pré-requis essentiel aux futurs recherches en mycologie médicale et au développement de stratégies de biologie synthétique. / The fungal CTG clade includes well-known yeasts of clinical importance and/or biotechnological potential. Thus, albeit being intensively studied over the last 30 years, their uncommon genetic code precludes the use of the widely available markers and reporter systems for genetic approaches in these microorganisms. We provide here a toolbox to genetically manipulate a wide range of CTG clade species. Firstly, we developed a new series of versatile controllable expression vectors for M. guilliermondii. After, we characterized MPA-resistant gene IMH3.2 et used it as a drug resistance marker in several yeast species. Finaly, we provide a molecular toolbox suitable to genetically manipulate a broad range of prominent species from the CTG clade. This versatile toolkit represents a new starting point for successful developments of research in medical mycology in the CTG clade but also will expedite synthetic biology strategies in these microorganisms for biotechnological applications.

CAG/CTG repeat instability is associated with at least 14 neurological disorders, including Huntington’s disease and Myotonic dystrophy type 1. In vitro and in vivo studies have showed that CAG/CTG repeats form a stable hairpin that is believed to be the intermediate for repeat expansion and contraction. Addition of extra DNA is essential for repeat expansion, so DNA synthesis is one of the keys for repeat expansion. In vivo studies reveal that 3’ CTG slippage with subsequent hairpin formation (henceforth called the 3’ CTG slippage hairpin) occurs during DNA synthesis. It is proposed that hairpin tolerance machinery is activated because prolonged stalling of DNA polymerase triggers severe DNA damage. As a means toward studying the hairpin-mediated expansion, we created a special hairpin substrate, mimicking the 3’ CTG slippage hairpin, to determine which polymerase promotes hairpin bypass. Our studies reveal polymerase β (pol β) is involved in the initial hairpin synthesis while polymerase δ (pol δ) is responsible for the resumption of DNA synthesis beyond the hairpin (extension step). Surprisingly, we also found that the pol δ can remove the short CTG hairpin by excision of the hairpin with its 3’ to 5’ exonuclease activity. Besides repairing the hairpin directly, resolving the hairpin is an alternative pathway to maintain CAG/CTG repeat stability. With limited understanding of which human helicase is responsible for resolving CAG/CTG hairpins, we conducted a screening approach to identify the human helicase involved. Werner Syndrome Protein (WRN) induces the hairpin repair activity when (CTG)35 hairpin is formed on the template strand. Primer extension assay reveals that WRN stimulates pol δ synthesis on (CAG)35/(CTG)35 template and such induction was still found in the presence of accessory factors. Helicase assay confirms that WRN unwinds CTG hairpin structures. Our studies provide a better understanding of how polymerases and helicases play a role in CAG/CTG repeat instability. Considering CAG/CTG repeat instability associated disorders are still incurable, our studies can provide several potential therapeutic targets for treating and/or preventing CAG/CTG repeat associated disorders.

La dystrophie myotonique de type 1 (DM1) est une maladie à transmission autosomale dominante causée par une répétition trinucléotidique CTG située dans la région 3’ non-traduite du gène dystrophia myotonica protein kinase (DMPK). La prévalence mondiale de la DM1 est de 8,26 personnes atteintes par 100 000 habitants : celle-ci est presque 20 fois plus importante au Saguenay-Lac-St-Jean en raison d’un effet fondateur. La présentation clinique de la DM1 peut comprendre divers symptômes dont de la faiblesse musculaire, de la myotonie, des cataractes, de l’insuffisance respiratoire, de l’arythmie cardiaque, de l’hypersomnolence et des troubles cognitifs et endocriniens. Par ailleurs, une grande variation dans la présence et la sévérité de ces symptômes est observée chez les patients et celle-ci n’est qu’en partie expliquée par la longueur des répétitions CTG. Plusieurs mécanismes pourraient expliquer la variabilité inexpliquée dont les défauts d’épissage, la mauvaise régulation des facteurs de transcription, la traduction non-ATG associée aux répétitions et les modifications épigénétiques, en particulier la méthylation de l’ADN. L’objectif de ce projet était donc d’évaluer l’impact de la méthylation de l’ADN au locus DMPK sur la variabilité phénotypique des patients atteints de DM1. Nous rapportons que la méthylation de l’ADN mesurée en amont et en aval de la répétition CTG est respectivement corrélée négativement et positivement avec la longueur de la répétition CTG. La présence d’une interruption de la répétition est associée à un niveau plus élevé de méthylation de l’ADN. À l’aide de modèles de régression linéaire multiple, nous démontrons que la méthylation de l’ADN contribue significativement et indépendamment de la longueur des répétitions CTG, à expliquer la variabilité́ de la force des dorsifléchisseurs de la cheville, de la force de préhension, de la force des pinces, de la capacité́ vitale forcée, du débit expiratoire de pointe, de la pression expiratoire et inspiratoire maximale. La méthylation de l’ADN explique une fraction de la variabilité phénotypique en DM1 et en association avec la longueur de la répétition CTG pourrait aider à améliorer la prédiction de la progression de la maladie chez ces patients. / Abstract : Myotonic dystrophy type 1 (DM1) is an autosomal dominant disorder caused by a CTG repeat extension in the 3’ untranslated region of the dystrophia myotonica protein kinase (DMPK) gene. Worldwide, the prevalence of DM1 is 8.26 affected persons per 100 000 persons, but it goes up to 158 affected persons per 100 000 in the Saguenay-Lac-St-Jean region of the province of Quebec (Canada) due to a founder effect. Clinical presentation includes muscular weakness, myotonia, cataracts, respiratory insufficiency, cardiac arrhythmia, hypersomnolence and endocrine and cognitive problems. There is a large variability in the presence and severity of these symptoms that is only partially explained by the CTG repeat length. Many mechanisms such as splicing defects, impaired regulation of transcription factors, repeat-associated non-ATG translation and epigenetic modifications, including DNA methylation, may explain this variability. The objective of this study was to assess the impacts of DNA methylation measured at the DMPK gene locus on phenotypic variability in DM1. We report that DNA methylation upstream of the repeat was negatively correlated with CTG repeat length whereas downstream DNA methylation was positively correlated. The presence of a variant repeat within the CTG repeat was associated with a higher level of DNA methylation. Linear multiple regression models support that DNA methylation contributes significantly and independently of the CTG repeat length to the variability of the ankle dorsiflexor, grip and pinch strengths, as well as forced vital capacity, peak expiratory flow and maximal inspiratory and expiratory pressures. DNA methylation could thus explain part of the phenotypic variability in DM1 and, together with CTG repeat length, could help improve the prediction of the progression of the disease.

Kardiotokografi (CTG) används idag under graviditet och förlossning för att övervaka fostrets hjärtfrekvens i förhållande till livmoderns värkar. Kurvan som erhålls av CTG-apparaten utvärderas av barnmorskan eller läkaren för patologiska mönster. Om CTG-kurvan är för avvikande kan det finnas misstanke om att fostret inte får tillräckligt med syre i livmodern. Dessa avvikelser är dock inte alltid ett tecken på att fostret inte mår bra vilket försvårar tolkningen av kurvorna för personalen. I detta arbete skapades en CTG-kurva utifrån en EKG-registrering gjort på ett lamm för att undersöka om metoden ger en tydlig CTG-kurva. Sedan analyserades kurvan för eventuella patologiska mönster. Resultatet blev en CTG-kurva med avvikelser. De patologiska mönster relaterade till variablerna basal hjärtfrekvens, acceleration och deceleration som förekom i hjärtfrekvenskurvan kunde återges i en graf med tillfredsställande kvalitet. / Cardiotocography (CTG) is used today during pregnancy and labour to monitor the fetal heartbeat in relation to uterine contractions. The graph obtained by the CTG machine is evaluated by the midwife or doctor for pathological patterns. If the CTG graph is too abnormal, there may be a suspicion that the fetus is not getting enough oxygen in the uterus. However, these abnormalities are not always a sign that the fetus is not feeling well, which makes the interpretation of CTG graphs difficult for the medical personnel. In this paper, a CTG graph was created based on an ECG recording taken on a lamb in order to investigate whether this method gives a clear CTG graph. The graph was then analyzed for any pathological patterns. The result was a CTG graph with deviations. The pathological patterns relating to the variables baseline heart rate, acceleration and deceleration that appeared in the heart rate curve could be represented in a graph with satisfactory quality.

No description available.

Made available in DSpace on 2014-06-11T19:31:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-26Bitstream added on 2014-06-13T21:02:09Z : No. of bitstreams: 1 luvizotto_ck_dr_mar.pdf: 1388530 bytes, checksum: 7033fc6e9a01e1488d8c9f3d16fff39d (MD5) / A presente tese tem como objetivo analisar a racionalização das tradições num contexto de modernidade tardia. A análise tem como ponto de partida as tradições gaúchas e sua manifestação nos Centros de Tradição Gaúcha (CTG). O estudo foi desenvolvido com base na bibliografia especializada sobre o tema e em uma pesquisa efetuada durante o ENART 2008 - Encontro de Arte e Tradição Gaúcha, realizado em 2008 na cidade de Santa Cruz do Sul – RS. Os estudos apontam que a modernidade tardia traz à tona a reflexividade e racionalização das relações, experiências e tradições. Tradições são (re)inventadas e, neste caso, (re)inventadas tendo o CTG como cenário e esta (re)invenção permite manter os vínculos e a sociabilidade do grupo sócio-cultural que se reconhece enquanto grupo e se diferencia dos demais por identificar-se em torno de símbolos, práticas, crenças e rituais que os une, pois é comum a todos eles, independente do espaço geográfico que ocupem. Na modernidade tardia o caráter de ludicidade atribuído às tradições (re)inventadas no CTG é o fio condutor para inúmeras relações que se estabelecem nesse cenário e é o combustível de todas as práticas e rituais vivenciados ali. A ludicidade das atividades dá sentido às práticas tradicionalistas e à toda tradição que foi (re)inventada e que passa a ser racionalizada no contexto de modernidade reflexiva. Conclui-se que essa apropriação do caráter lúdico das tradições e as relações estabelecidas no CTG a partir dos símbolos, práticas e rituais sinalizam que estamos vivenciando no Brasil um contexto de modernidade tardia. No contexto da modernidade tardia, a tradição racionalizada é uma maneira de evitar choques entre diferentes valores e modos de vida, uma vez que age como articuladora de atores e grupos sociais, entre as diferentes instâncias do mundo social. / This thesis analyzes the rationalization of the traditions in the context of late modernity. The analysis takes as its starting point the Gaúcho traditions and its manifestation in the Centers of Gaúcho Tradition (CTG). The study was developed based on the professional literature on the subject and in a survey conducted during the ENART 2008 - Meeting of Art and Gaúcho Tradition, held in 2008 in Santa Cruz do Sul - RS. The research suggests that late modernity brings to light the reflectivity and rationalization of the relationships, experiences and traditions. Traditions are (re) invented and, in this case, (re) invented having the CTG as a backdrop and this (re) invention keeps the links and the sociability of the socio-cultural group, that is recognized as a group, and differentiates itself by identifying them around symbols, practices, beliefs and rituals that unites them, because it is common to all, regardless of geographical space they occupy. In late modernity, the character of playfulness attributed to traditions are (re) invented in CTG and it is the thread for many relationships established in this scenario and is the fuel of all the experienced practices and rituals. The playfulness of the activities gives practical meaning to traditionalists and the whole tradition that has been (re) invented and which is being rationalized in the context of reflexive modernity. It was concluded that this ownership of the playful character of the traditions and relationships with the CTG around the symbols, rituals and practices, indicates that we are experiencing in Brazil a context of late modernity. In the context of late modernity, tradition is a streamlined way to avoid clashes between different values and ways of life, since it acts as articulator of actors and social groups, between different instances of the social world.

How to allocate resources in the health care sector is academically dealt with within the subject of health economics. Economic evaluations are within this area used to compare the costs and effects of medical interventions with the purpose to help decision makers decide how to allocate resources. Oxygen deficiency in the foetus during birth can lead to severe life long injuries in the child. In high-risk deliveries, it is therefore considered necessary to use foetal surveillance with a scalp electrode and the choice is between surveillance with internal cardiotocography (CTG) and surveillance with ST analysis. The standard procedure is in most hospitals currently CTG, which records the foetal heart rate and the uterine contractions. The second strategy, in this thesis referred to as ST analysis, complements CTG with foetal electrocardiography(ECG) and ST analysis. The objective of this report is to from a societal perspective determine the cost-effectiveness of using ST analysis in complicated deliveries, compared to the use of CTG alone. A cost-utility analysis was performed based on a probabilistic decision model incorporating the relevant strategies and outcomes. The costs and effects of the two different treatment strategies were compared in a decision tree. Discounted costs and quality-adjusted life-years (QALYs) were measured and simulated over a life-time perspective. The analysis resulted in an incremental effect of 0.005 QALYs for the ST analysis strategy, when compared to the CTG strategy. ST analysis was also associated with a €30 lower cost. Thus, CTG is dominated by the ST analysis strategy. The probability that ST analysis is the cost-effective alternative is high for all values of willingness-to-pay for a QALY, which means that a decision to implement the ST analysis strategy based on the results of this thesis would be surrounded by a low degree of uncertainty.

<p>How to allocate resources in the health care sector is academically dealt with within the subject of health economics. Economic evaluations are within this area used to compare the costs and effects of medical interventions with the purpose to help decision makers decide how to allocate resources.</p><p>Oxygen deficiency in the foetus during birth can lead to severe life long injuries in the child. In high-risk deliveries, it is therefore considered necessary to use foetal surveillance with a scalp electrode and the choice is between surveillance with internal cardiotocography (CTG) and surveillance with ST analysis. The standard procedure is in most hospitals currently CTG, which records the foetal heart rate and the uterine contractions. The second strategy, in this thesis referred to as ST analysis, complements CTG with foetal electrocardiography(ECG) and ST analysis.</p><p>The objective of this report is to from a societal perspective determine the cost-effectiveness of using ST analysis in complicated deliveries, compared to the use of CTG alone. A cost-utility analysis was performed based on a probabilistic decision model incorporating the relevant strategies and outcomes. The costs and effects of the two different treatment strategies were compared in a decision tree. Discounted costs and quality-adjusted life-years (QALYs) were measured and simulated over a life-time perspective.</p><p>The analysis resulted in an incremental effect of 0.005 QALYs for the ST analysis strategy, when compared to the CTG strategy. ST analysis was also associated with a €30 lower cost. Thus, CTG is dominated by the ST analysis strategy. The probability that ST analysis is the cost-effective alternative is high for all values of willingness-to-pay for a QALY, which means that a decision to implement the ST analysis strategy based on the results of this thesis would be surrounded by a low degree of uncertainty.</p>