Object: The aim of the study was to evaluate the early changes in pituitary hormone levels after severe traumatic brain injury (sTBI) and compare hormone levels to basic neuro-intensive care data, a systematic scoring of the CT-findings and to evaluate whether hormone changes are related to outcome. Methods: Prospective study, including consecutive patients, 15-70 years, with sTBI, Glasgow Coma Scale (GCS) score <= 8, initial cerebral perfusion pressure > 10 mm Hg, and arrival to our level one trauma university hospital within 24 hours after head trauma (n = 48). Serum samples were collected in the morning (08-10 am) day 1 and day 4 after sTBI for analysis of cortisol, growth hormone (GH), prolactin, insulin-like growth factor 1 (IGF-1), thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), follicular stimulating hormone (FSH), luteinizing hormone (LH), testosterone and sex hormone-binding globulin (SHBG) (men). Serum for cortisol and GH was also obtained in the evening (17-19 pm) at day 1 and day 4. The first CT of the brain was classified according to Marshall. Independent staff evaluated outcome at 3 months using GOS-E. Results: Profound changes were found for most pituitary-dependent hormones in the acute phase after sTBI, i.e. low levels of thyroid hormones, strong suppression of the pituitary-gonadal axis and increased levels of prolactin. The main findings of this study were: 1) A large proportion (54% day 1 and 70% day 4) of the patients showed morning s-cortisol levels below the proposed cut-off levels for critical illness related corticosteroid insufficiency (CIRCI), i.e. < 276 nmol/L (= 10 ug/dL), 2) Low s-cortisol was not associated with higher mortality or worse outcome at 3 months, 3) There was a significant association between early (day 1) and strong suppression of the pituitary-gonadal axis and improved survival and favorable functional outcome 3 months after sTBI, 4) Significantly lower levels of fT3 and TSH at day 4 in patients with a poor outcome at 3 months. 5) A higher Marshall CT score was associated with higher day 1 LH/FSH-and lower day 4 TSH levels 6) In general no significant correlation between GCS, ICP or CPP and hormone levels were detected. Only ICPmax and LH day 1 in men was significantly correlated. Conclusion: Profound dynamic changes in hormone levels are found in the acute phase of sTBI. This is consistent with previous findings in different groups of critically ill patients, most of which are likely to be attributed to physiological adaptation to acute illness. Low cortisol levels were a common finding, and not associated with unfavorable outcome. A retained ability to a dynamic hormonal response, i.e. fast and strong suppression of the pituitary-gonadal axis (day 1) and ability to restore activity in the pituitary-thyroid axis (day 4) was associated with less severe injury according to CT-findings and favorable outcome.

Tornadoes are one of Mother Nature’s deadliest phenomena. They affect a large region of the United States. The risk of tornadoes is contingent on dynamic atmospheric conditions that are most likely during spring but which can occur anytime of the year, making the storms challenging to forecast. Using geographical information systems (GIS), a web-based spatial decision support system (SDSS) was created to help understand the spatial dimension of tornado risk assessment. The risk values are calculated using Tornado Days rather than taking a crude density measurement. The SDSS hosts GIS web services that are displayed on an Adobe Flex application. The web application allows users to view, research, query and extract information from the attributes of the GIS files. There is also a dynamic risk tool which gives users the ability to click anywhere inside the study area and get the percentage of risk that a tornado will occur within 25 miles of that very point. The web application eliminates users and viewers from conducting their own research and GIS work. In addition, automated updating models and macros were created to update the tornado database on an annual basis.

Early childhood malnutrition is a global public health problem with serious short- and long-term consequences. The aim of this thesis is to evaluate the effects of psychosocial stimulation (PS) with or without food supplementation (FS) on growth and development of severely malnourished children, quality of home environment, mother’s child-rearing practices and depressive symptoms. The study setting was Dhaka, Bangladesh, and the participants were severely malnourished children, aged 6-24 months, admitted at Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). A hospital-based study was conducted in Nutrition Rehabilitation Unit of ICDDR,B hospital, where a control group (n=43) was studied initially, followed by an intervention group (n=54). All received standard nutrition rehabilitation care. The intervention group received daily group meetings and play sessions in the hospital, and was thereafter visited at home for 6 months. A community-based randomised trial was conducted including children (n=507) admitted at hospital for initial treatment of an acute infection, and thereafter assigned to PS, FS, PS+FS, clinic control or hospital control groups. PS was delivered at follow-up visits, fortnightly for 6 months at community clinics. FS included distribution of cereal-based food packets (150–300 kcal/day depending on age) for 3 months. All groups received standard medical care and micronutrient supplementation. In the hospital-based study, the intervention group had significantly higher scores in mental (p<0.001, effect size 0.52 SD) and motor development (p=0.047, effect size 0.37 SD), and weight (p=0.03, effect size 0.39 SD), after 6- months intervention. In the community-based trial, there was a significant effect of stimulation after six months of intervention on children’s mental development (group*session interaction p=0.037, effect size=0.37 SD) and weight (group*session interaction p=0.02, effect size=0.26 SD) but no effect on motor development or linear growth. The PS+FS and PS groups differed in total HOME score, two HOME subscales (maternal involvement and play materials), and in mother’s child- rearing practices scores but not in depressive symptoms. PS with or without FS had small improvement on children’s growth and development, quality of home environment and mother’s rearing-practices of severely malnourished children. More intensive interventions with longer duration are therefore recommended.

The relationship to professionals has proved to be a helping factor for personswith severe mental illness, but it is also a relationship characterised by anunbalanced power relation. The aim of this study was to compile and analyze theknowledge of what persons with severe mental illness themselves consider to behelping in the relationship to professionals, and to specifically analyse this from apower perspective. The analysis was conducted using Foucault’s ideas of powerand knowledge, and an empowerment perspective. The method used was anarrative review. Fourteen relevant studies were included, in which fouroverarching themes were identified; building the basis for helping, workingtogether, more than a consumer and the professional role. The institutionalisedknowledge regarding the consumers, their problems and in which way thisrelationship is helping, was understood as an integral part of the power within therelationship. To share power by looking beyond this knowledge, going beyond theinstitutionalised way of helping and instead taking the consumer’s view intoaccount, was seen as helping. This knowledge calls for professionals to, inambition to helping individuals with severe mental illness, be open to the variousdifferent ways of doing so.

Ultra-fine grained (UFG) materials have attracted considerable interest due to the possibility of achieving simultaneous increase in strength and ductility. Effective use of these materials in engineering applications requires investigating the processing-microstructure-property inter-relations leading to a comprehensive understanding of the material behavior. Research efforts on producing UFG hexagonal close packed (hcp) materials have been limited in spite of their envisaged utilization in various technologies. The present study explores multiple UFG hcp materials to identify the general trends in their deformation behaviors, microstructural features, crystallographic texture evolutions and mechanical responses under strain path changes. UFG hcp materials, including commercial purity Ti, Ti-6Al-4V alloy and high purity Zr, were fabricated using equal channel angular extrusion (ECAE) as a severe plastic deformation (SPD) technique following various processing schedules. Several characterization methods and a polycrystal plasticity model were utilized in synergy to impart the relationships between the UFG microstructure, the texture and the post-ECAE flow behavior. Pure UFG hcp materials exhibited enhanced strength properties, making them potential substitutes for coarse-grained high strength expensive alloys. Incorporation of post-ECAE thermo-mechanical treatments was effective in further improvement of the strength and ductility levels. Strong anisotropy of the post-ECAE flow response was evident in all the materials studied. The underlying mechanisms for anisotropy were identified as texture and processing-induced microstructure. Depending on the ECAE route, the applied strain level and the specific material, the relative importance of these two mechanisms on plastic flow anisotropy varied. A viscoplastic self-consistent approach is presented as a reliable model for predicting the texture evolutions and flow behaviors of UFG hcp materials in cases where texture governs the plastic anisotropy. Regardless of the material, the initial billet texture and the extrusion conditions, ECAE of all hcp materials revealed similar texture evolutions. Accurate texture and flow behavior predictions showed that basal slip is the responsible mechanism for such texture evolution in all hcp materials independent of their axial ratio. High strength of the UFG microstructure was presented as a triggering mechanism for the activation of unexpected deformation systems, such as high temperature deformation twinning in Ti-6Al-4V and room temperature basal slip in pure Zr.

This study explores the moods and behavior of an emotionally impaired child before and after therapeutically oriented painting activities and assesses the effectiveness of this assistance method. The study employs qualitative research methods. The subject of this study is a fourth-grade emotionally impaired student who participated in painting activities twice each week, for a total of 16 sessions. Data was collected throughout the sessions via photography, audio and video recordings and analyzed for verbal descriptions, non-verbal expression, and interaction with the researchers. In addition, assessment, observation, and interviews of the student's mother and school personnel (administrators, guidance personnel, resource class teachers, guidance teachers, and class mothers) were used to gain an understanding of how effective therapeutically oriented painting activities are as a means of helping emotionally impaired children. This study reached the following conclusions from the research findings: (1) There was a significant improvement in the child¡¦s interpersonal relationships following the painting activities. (2) The child participated actively in family activities, and displayed positive interaction with his mother and older brother. (3) The child displayed significant positive changes in terms of innate abilities, learning motivation, self-affirmation, and personal growth. (4) The child's in-school performance displayed significant progress. (5) The child's communication abilities increased dramatically.

The objectives of this research study are: 1. To probe into the widespread period of severe acute respiratory syndrome. 2. To study on this highly contagious and rapid spread of this new kind of disease At the time when nearby emergency department of medical center breaks out a suspicion of nasocomial infection. First, our emergency department immediately formed a strict fever screening station. After comparing the outcome of the prevention and spreading of this disease by the set-up of the emergency fever station between the central and southern medical institution. The research period was from May 15, 2003to July 15, 2003. Our research targets made by the emergency fever station were around 3730 patients with a random selection of 300 cases. This research uses the structure of fever screening measurement questionnaires to gather information and then adapted the EP1-INFO 10.0 version of statistical analysis. The results of the research are as follows: 1. Chief complaint of sore throat (38.3%) and fever (17%) fitted to the clinical symptoms of SARS. In relation to SARS before and after the spread of the disease, there are still other complaints such as the gastrointestinal system (18.7%) and cardiovascular disease (16.7%) that showed no obvious difference. 2. During the period of emergency fever screening station, an additional 50% of manpower are being arranged to screen probable or non-probable affected cases. (from the 300 randomly selected cases) 3. There are no obvious difference showed after comparing the outcome of the prevention and spreading of this disease by the set-up of the emergency fever center between the central and southern medical institution. 4. After tallying the number of doctors and nurses participated in screening procedure and number of non-medical staff developed similar symptoms to SARS, we can see the result of total number of medical staff from the emergency fever screening station that can successfully control the spread and prevention of the disease, making it the standard and model in the prevention and control of other communicable disease in the future. Key words: Severe acute respiratory syndrome, fever screening station, emergency room, emergency task force

High Pressure Torsion (HPT) is one of the most widely used severe plastic deformation methods which enable to obtain a crack free ultra-fine grained bulk material with improved mechanical properties like increased strength and toughness. In the process, a disc shaped sample is pressed between two anvils and deformed via surface friction forces by rotating one of the anvils. The aim of this study is to nondestructively characterize the variations in the deformation uniformity of the severely deformed steel disks. Two sets of low carbon steel samples were obtained by applying the unconstrained and constrained HPT process up to 6 turns. Magnetic Barkhausen Noise (MBN) method was used in order to evaluate the samples in a nondestructive manner via a commercial device. The results of the MBN measurements were verified with those of conventional methods such as / x-ray diffraction (XRD), metallographic examination and hardness measurements. The initial stages of HPT revealed the effects of conventional plastic deformation on MBN / however with further straining, grain size refinement prevailed and caused increase in MBN signals.

Dissimilar Channel Angular Pressing (DCAP) method is an effective Severe Plastic Deformation (SPD) technique to improve the mechanical properties of sheets or strips by producing ultrafine grains. The aim of this study is to investigate the evolution of the microstructure and the improvement in mechanical properties of 6061 Al-alloy strips deformed by DCAP up to 5 passes. Mechanical properties such as hardness and strength have been observed to increase up to a certain strain level depending on the microstructural evolution. These microstructural changes were investigated by the characterization studies of XRD, SEM and TEM analysis of the DCAPed samples indicating the subgrain formation, changes in the dislocation density and dislocation behaviors.

NiTiHf alloys have attracted considerable attention as potential high temperature Shape Memory Alloy (SMA) but the instability in transformation temperatures and significant irrecoverable strain during thermal cycling under constant stress remains a major concern. The main reason for irrecoverable strain and change in transformation temperatures as a function of thermal cycling can be attributed to dislocation formation due to relatively large volume change during transformation from austenite to martensite. The formation of dislocations decreases the elastic stored energy, and during back transformation a reduced amount of strain is recovered. All these observations can be attributed to relatively soft lattice that cannot accommodate volume change by other means. We have used Equal Channel Angular Extrusion (ECAE), hot rolling and marforming to strengthen the 49.8Ni-42.2Ti-8Hf (in at. %) material and to introduce desired texture to overcome these problems in NiTiHf alloys. ECAE offers the advantage of preserving billet cross-section and the application of various routes, which give us the possibility to introduce various texture components and grain morphologies. ECAE was performed using a die of 90º tool angle and was performed at high temperatures from 500ºC up to 650ºC. All extrusions went well at these temperatures. Minor surface cracks were observed only in the material extruded at 500 °C, possibly due to the non-isothermal nature of the extrusion. It is believed that these surface cracks can be eliminated during isothermal extrusion at this temperature. This result of improved formability of NiTiHf alloy using ECAE is significant because an earlier review of the formability of NiTiHf using 50% rolling reduction concluded that the minimum temperature for rolling NiTi12%Hf alloy without cracks is 700°C. The strain level imposed during one 90° ECAE pass is equivalent to 69% rolling reduction. Subsequent to ECAE processing, a reduction in irrecoverable strain from 0.6% to 0.21% and an increase in transformation strain from 1.25% to 2.18% were observed at a load of 100 MPa as compared to the homogenized material. The present results show that the ECAE process permits the strengthening of the material by work hardening, grain size reduction, homogeneous distribution of fine precipitates, and the introduction of texture in the material. These four factors contribute in the increase of stability of the material. In this thesis I will be discussing the improvement of mechanical behavior and stability of the material achieved after various passes of ECAE.