Magister Scientiae Dentium - MSc(Dent) / In this case study research project I have determined that multidrug sedation in children younger than eight years are possible.Conscious sedation [or sedation where verbal contact with the patient is possible] can be used successfully to decrease anxiety and fear for unpleasant experiences, like dental procedures. Behaviour therapy in conjunction with one or more drugs can be used to depress the central nervous system in order to decrease the patient’s awareness of unpleasant stimuli. This enables treatment to be carried out without patient interference. Extensive literature surveys were done to determine the ideal drugs as well as the ideal route for conscious sedation in dental treatment for children. In this study project drugs like midazolam, propofol, alfentanyl and ketamine were titrated intravenously to achieve conscious sedation. / South Africa

Introdução: A doença de Wilson (DW) é uma doença genética rara, sistêmica, causada por déficit no metabolismo do cobre, levando a acúmulo em diversos órgãos, incluindo o cérebro, especialmente os núcleos da base. Apesar de distonia e disartria serem as alterações neurológicas mais comuns, alterações cognitivas, incluindo demência, podem surgir em casos não tratados. Objetivos: Avaliar as funções cognitivas de um grupo de pacientes com DW e correlacionar com os achados de RM e SPECT. Métodos: Todos os pacientes com DW atendidos consecutivamente em uma clínica de distúrbios do movimento, entre outubro de 2006 e agosto de 2007, foram submetidos ao Miniexame do Estado Mental (MEEM), Bateria Cognitiva Breve (BCB), teste de fluência verbal (animais, FAS e verbos), Bateria de Avaliação Frontal (BAF), STROOP, Extensão de Dígitos (ED) ordem direta e ordem inversa, Escala de Demência de Mattis (DRS), Teste de Seleção de Cartas de Wisconsin (WCST), Hooper e Blocos do WAIS. Depois dos testes, todos os pacientes realizaram RM e SPECT. Alterações de RM (hipersinal, hiposinal e atrofia) foram quantificadas em uma escala (0-17). O SPECT foi analisado por meio de SPM. Pacientes com depressão ou com anartria foram excluídos. Os resultados foram comparados com o desempenho de um grupo de voluntários sadios. Resultados: 20 pacientes com DW (11 homens) e 20 controles (9 homens) foram avaliados. A média de idade no grupo de pacientes com DW e controles foi 30,05±7,25 anos e 32,15±5,37 anos, respectivamente. A escolaridade média foi 11,15±3,73 anos nos pacientes com DW e 10,08 ± 2,62 anos nos controles. Pacientes com DW tiveram comprometimento cognitivo nos seguintes testes: MEEM (26,70±2,45 x 28,75±1,29), DRS (132,45 ±10,77 x 140,55±3,72), Fluência verbal: FAS (22,40±12,40 x 38,75±9,11) e Verbos (8,50±6,63 x 15,40±6,22); ED ordem direta (4,95±0,82 x 6,15±1,42), STROOP (4,40±4,87 x 0,50±0,68), BAF (12,95±2,85 x 16,25±1,25) e BCB: M2 (9,20±0,69 x 9,75±0,44), M5 (8,45±1,35 x 9,50 ±0,76). O diagnóstico de demência foi realizado em dois pacientes. Houve correlação entre o comprometimento cognitivo e a escala de RM (r=0,5348). Essa correlação foi mais forte com as alterações de hipersinal e atrofia (r=0,718). A avaliação por SPM mostrou uma hipoperfusão no caudado de forma simétrica, no cerebelo à esquerda e insula à esquerda. Conclusões: Pacientes com DW apresentam um comprometimento cognitivo, especialmente nas funções executivas, com boa correlação entre cognição e RM / Background: Wilsons disease (WD) is a rare, genetic and systemic disease, caused by a deficit in the copper metabolism, leading to its accumulation in different organs, including the brain, especially the basal ganglia. Although dystonia and dysarthria are the most common neurological signals, cognitive changes, including dementia, may emerge in untreated cases. Objective: To assess cognitive functioning of a group of WD patients and correlate with MRI and SPECT findings. Methods: All WD patients consecutively attended in a Movement Disorders Clinic between October 2006 and August 2007 were submitted to the Mini-Mental State Examination (MMSE), Brief Cognitive Screening Battery (BCSB), verbal fluency tests (animals, FAS and verbs), the Frontal Assessment Battery (FAB), STROOP, Digit Span forward and backward (DS), Dementia Ranting Scale (DRS), Wisconsin Card Sorting Test (WCST), Hooper and WAIS block design. After the tests, a MRI and SPECT were done in all patients. MRI abnormalities (high intensity signal, low intensity signal and atrophy) were ratted in a scale (0-17). SPECT was analyzed with SPM. Patients with depression or with anarthria were excluded. Results were compared with the performance of a group of healthy controls. Results: 20 WD patients (11 men) and 20 controls (9 men) were evaluated. Mean age in the WD and control groups were 30.05±7.25 years and 32.15±5.37, respectively. Mean educational level was 11.15±3.73 years among WD cases and 10.08 ± 2.62 years among controls. The WD patients had a cognitive impairment in the: MMSE (26.70±2.45 x 28.75±1.29), DRS (132.45 ±10.77 x 140.55±3.72), verbal fluency: FAS (22.40±12.40 x 38.75±9.11), Verbs (8.50±6.63 x 15.40±6.22); DS forward (4.95±0.82 x 6.15±1.42), STROOP (4.40±4.87 x 0.50±0.68), FAB (12.95±2.85 x 16.25±1.25) and BCSB: M2 (9.20±0.69 x 9.75±0.44), M5 (8.45±1.35 x 9.50 ±0.76). Dementia diagnostic was made in tow patients. There was a correlation between cognitive impairment and MRI scale (r=0.5348), this correlation was better with high intensity signal plus atrophy (r=0.718). The SPM showed a symmetrical caudate, left cerebellar and left insular hypoperfusion. Conclusion: WD patients presented cognitive impairment, especially in executive functions, with good correlation between cognition and MRI

On May 9, 1950, President Truman declared that “all our international policies, taken together, form a program designed to strengthen and unite the free world.” My dissertation is the first history of the “free world,” a crucial concept that identified the object of U.S. leadership, drove the country to seek global preeminence, and shaped the American understanding of the Cold War. For much of the nineteenth century, American policymakers had envisioned a globe divided into a “new world” of freedom and an “old world” of tyranny. In 1917, Woodrow Wilson proposed a new global dichotomy, arguing for the creation of a trans-Atlantic coalition of democracies against aggressive autocracies whose very existence threatened the survival of freedom everywhere. A revised version of this logic prevailed during the Second World War. But it was only after the start of the Cold War in the late 1940s that American policymakers embraced the concept of an enduring and extra-hemispheric “free world.” Their efforts to lead, unite and strengthen this spatially defined “free world” prompted a massive expansion of American foreign policy and fundamentally transformed the country’s position in the international arena.

Die vorliegende medizinische Dissertation beschäftigt sich mit der Evaluation nicht-invasiver Diagnostikverfahren zur Detektion einer Leberfibrose bei Patienten mit Morbus Wilson. Untersucht wurden die Transiente Elastographie (TE), die Acoustic Radiation Force Impulse (ARFI)-Elastographie sowie verschiedene laborbasierte Fibrose-Indices bezüglich der Anwendbarkeit und ihres diagnostischen Nutzens. Der Morbus Wilson ist eine seltene hereditäre Kupferspeicherkrankheit, die über Kupferakkumulation im Leberparenchym zur Ausbildung einer Zirrhose führen kann. Die Kenntnis des Leberfibrosegrades ist unabdingbar für therapeutische Entscheidungen und prognostische Einschätzungen. Dafür sind regelmäßige Kontrollen der Leber im Krankheitsverlauf notwendig, wobei die Leberbiopsie den diagnostischen Goldstandard darstellt. Die Invasivität sowie das Komplikationspotential limitieren jedoch deren wiederholte Anwendbarkeit. TE sowie ARFI bieten hierzu eine moderne Alternative, deren Nutzen anhand großer Studien bei Patienten mit verschiedenen chronischen Lebererkrankungen bereits aufgezeigt werden konnte. Die Verfahren beurteilen die Parenchymsteifigkeit als Surrogatparameter der Leberfibrose, wobei mit steigendem Fibrosegrad die Gewebesteifigkeit zunimmt. Die Grenzwerte zur Definition des Fibrosegrades sowie die Anwendbarkeit beider Verfahren variieren in Abhängigkeit von der Grunderkrankung. Ziel dieser Studie war es, Grenzwerte und diagnostischen Nutzen der Elastographieverfahren bei M. Wilson zu definieren. Beide Verfahren können eine Leberbeteiligung des M. Wilson nachweisen und das Vorliegen einer Leberzirrhose detektieren. Die potentiell bessere diagnostische Treffsicherheit der TE wird durch Einschränkungen in der Anwendbarkeit limitiert.

The aim of this study is to examine how psychedelic posters from the 1960’s relate to postersfrom the late 19th century Art Nouveau, and how their similarities and differences are expressed in imagery and experience. The method applied is Peter Gillgrens theory about performativity, which is how we interpret art based on its experience, and Margaretha Rossholm Lagerlöf's theory about how to interpret imagery. This applies to a selected number of posters from the 1960’s and from the Art Nouveau period that bears great similarity, after having gone through the historic background of the different eras and what connects them.The results show that there is a difference between Art Nouveau and 1960's poster art, despite their similarity, that is expressed through the imagery and experience. The posters from the 1960’s shows independence from Art Nouveau by expressing an original type of art thatcaptures the counter culture of the 1960’s, and therefore uses Art Nouveau as a way of appropriation.

It always exists different methods/models to build a yield curve from a set of observed market rates even when the curve completely reproduces the price of the given instruments. To create an accurate and smooth interest rate curve has been a challenging all the time. The purpose of this thesis is to use the real market data to construct the yield curves by the bootstrapping method and the Smith Wilson model in order to observe and compare the performance ability between the models. Furthermore, the extended Nelson Siegel model is introduced without implementation. Instead of implementation I compare the ENS model and the traditional bootstrapping method from a more theoretical perspective in order to perceive the performance capabilities of them.

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