The effects of 2 mg chlormadinone acetate/30 mcg ethinylestradiol, alone or combined with spironolactone, on cardiovascular risk markers in women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder associated with metabolic dysfunction and changes in cardiovascular risk markers, and using oral contraceptives (OCs) may exert a further negative effect on these alterations in patients with PCOS. Thus, the primary objective of this study was to assess the effects on arterial function and structure of an OC containing chlormadinone acetate (2 mg) and ethinylestradiol (30 mcg), alone or combined with spironolactone (OC+SPL), in patients with PCOS. Study Design: This was a randomized, controlled clinical trial. Fifty women with PCOS between 18 and 35 years of age were randomized by a computer program to use OC or OC+SPL. Brachial artery flow-mediated vasodilation, carotid intima-media thickness and the carotid artery stiffness index were evaluated at baseline and after 6 and 12 months. Serum markers for cardiovascular disease were also analyzed. The intragroup data were analyzed using analysis of variance with Tukey's post hoc test. A multivariate linear regression model was used to analyze the intergroup data. Results: At 12 months, the increase in mean total cholesterol levels was greater in the OC+SPL group than in the OC group (27% vs. 13%, respectively; p=.02). The increase in mean sex hormone-binding globulin levels was greater in the OC group than in the OC+SPL group (424% vs. 364%, respectively; p=.01). No statistically significant differences between the groups were found for any of the other variables. Conclusion: The addition of spironolactone to an OC containing chlormadinone acetate and ethinylestradiol conferred no cardiovascular risk-marker advantages in young women with PCOS. (C) 2012 Elsevier Inc. All rights reserved.

Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome

Objective: To evaluate the association between Apgar scores of less than seven at five minutes (AS(5min) < 7) and antenatal factors and postnatal outcomes. Methods: A retrospective cohort and case-control study of 27,252 consecutive term newborns in a low risk obstetrical population between January 2003 and December 2010. Maternal and infant databases were reviewed from all cases with AS(5min) < 7 (n = 121; 0.4%) and 363 cases with AS(5min) >= 7 at 5 minutes who were randomly selected by a computer program. The main outcomes were neonatal death, newborn respiratory distress, need for orotracheal intubation and neonatal intensive care unit (NICU), and hypoxic-ischemic-encephalopathy. Results: After multiple regression analysis, repeated late decelerations on cardiotocography (OR: 2.4; 95% CI: 1.4-4.1) and prolonged second stage of labor (OR: 3.3; 95% CI: 1.3-8.3) were associated with AS(5min) < 7, as well as neonatal respiratory distress (OR: 3.0; 95% CI: 1.3-6.9), orotracheal intubation (OR: 2.5; 95% CI: 1.2-4.8), need for NICU (OR: 9.5; 95% CI: 6.7-16.8), and hypoxic-ischemic-encephalopathy (OR: 14.1; 95% CI: 3.6-54.7). No other antenatal factors were associated with AS(5min) < 7 (p > 0.05). Conclusion: Repeated late decelerations and prolonged second stage of labor in the low-risk population are predictors of AS(5min) < 7, a situation associated with increased risk of neonatal respiratory distress, need for mechanical ventilatory support and NICU, and hypoxic-ischemic-encephalopathy.

Pollen and seed flow patterns of Carapa guianensis Aublet. (Meliaceae) in two types of Amazonian forest

Various factors affect spatial genetic structure in plant populations, including adult density and primary and secondary seed dispersal mechanisms. We evaluated pollen and seed dispersal distances and spatial genetic structure of Carapa guianensis Aublet. (Meliaceae) in occasionally inundated and terra firme forest environments that differed in tree densities and secondary seed dispersal agents. We used parentage analysis to obtain contemporary gene flow estimates and assessed the spatial genetic structure of adults and juveniles. Despite the higher density of adults (diameter at breast height >= 25 cm) and spatial aggregation in occasionally inundated forest, the average pollen dispersal distance was similar in both types of forest (195 +/- 106 m in terra firme and 175 +/- 87 m in occasionally inundated plots). Higher seed flow rates (36.7% of juveniles were from outside the plot) and distances (155 +/- 84 m) were found in terra firme compared to the occasionally inundated plot (25.4% and 114 +/- 69 m). There was a weak spatial genetic structure in juveniles and in terra firme adults. These results indicate that inundation may not have had a significant role in seed dispersal in the occasionally inundated plot, probably because of the higher levels of seedling mortality.

Análise das distorções em leituras angulares de imagens fotográficas

CONTEXTUALIZAÇÃO: A biofotogrametria é uma técnica difundida na área da saúde e, apesar dos cuidados metodológicos, há distorções nas leituras angulares das imagens fotográficas. OBJETIVO: Mensurar o erro das medidas angulares em imagens fotográficas com diferentes resoluções digitais em um objeto com ângulos pré-demarcados. MÉTODOS: Utilizou-se uma esfera de borracha com 52 cm de circunferência. O objeto foi previamente demarcado com ângulos de 10º, 30º, 60º e 90º, e os registros fotográficos foram realizados com o eixo focal da câmera a três metros de distância e perpendicular ao objeto, sem utilização de zoom óptico e com resolução de 3, 5 e 10 Megapixels (Mp). Todos os registros fotográficos foram armazenados, e os valores angulares foram analisados por um experimentador previamente treinado, utilizando o programa ImageJ. As aferições das medidas foram realizadas duas vezes, com intervalo de 15 dias entre elas. Posteriormente, foram calculados os valores de acurácia, erro relativo e em graus, precisão e Coeficiente de Correlação Intraclasse (ICC). RESULTADOS: Quando analisado o ângulo de 10º, a média da acurácia das medidas foi maior para os registros com resolução de 3 Mp em relação às resoluções de 5 e 10 Mp. O ICC foi considerado excelente para as três resoluções de imagem analisadas e, em relação aos ângulos analisados nos registros fotográficos, pôde-se verificar maior acurácia, menor erro relativo e em graus e maior precisão para o ângulo de 90º, independentemente da resolução da imagem. CONCLUSÃO: Os registros fotográficos realizados com a resolução de 3 Mp proporcionaram medidas de maiores valores de acurácia e precisão e menores valores de erro, sugerindo ser a resolução mais adequada para gerar imagem de ângulos de 10º e 30º.

Contribuição da inclusão de polpa cítrica e casca de soja para a qualidade da silagem de resíduo úmido de cervejaria

Com o objetivo de avaliar a produção da silagem e o uso de aditivos no processo de ensilagem do resíduo úmido de cervejaria, foram realizados 5 tratamentos: controle (C: ensilagem de 100% de resíduo úmido de cervejaria); PC15 (15% de polpa cítrica); PC30 (30% de polpa cítrica); CS15 (15% de casca de soja); CS30 (30% de casca de soja) – com base na matéria fresca do resíduo de cervejaria. As silagens foram confeccionadas em baldes plásticos com 252mm de altura e 245mm de diâmetro (0,06174m³), e amostras foram coletadas para análises bromatológicas, pH, nitrogênio amoniacal, digestão in vitro de matéria seca, ácidos orgânicos e perfil microbiológico. Os resultados foram analisados pelo programa computacional Statistical Analysis System (Statistical..., 1985), sendo verificada a normalidade dos resíduos pelo Teste de Shapiro-Wilk (PROC UNIVARIATE), e as variâncias, pelo Teste de Hartley. Os efeitos dos níveis de adição foram separados por meio de contrastes polinomiais utilizando o nível de significância de 5%. Houve aumento do teor de matéria seca, carboidratos solúveis, ácido lático, digestão in vitro de matéria seca, da população de bactérias ácido láticas e redução do pH, ácido butírico, propiônico e nitrogênio amoniacal a partir das inclusões de polpa cítrica e casca de soja, sendo os melhores resultados encontrados para o tratamento com inclusão de 30% de polpa cítrica (P<0,05). A ensilagem do bagaço de malte por si só é uma alternativa para o produtor rural como suporte alimentar e confecção de silagem de qualidade que pode ser incrementada com o uso de aditivos a serem avaliados de acordo com a relação custo-benefício para eficiência da produção

NURSES' PERCEPTION REGARDING THE IMPLEMENTATION OF COMPUTER-BASED CLINICAL NURSING DOCUMENTATION

This qualitative, exploratory, descriptive study was performed with the objective of understanding the perception of the nurses working in medical-surgical units of a university hospital, regarding the strategies developed to perform a pilot test of the PROCEnf-USP electronic system, with the purpose of computerizing clinical nursing documentation. Eleven nurses of a theoretical-practical training program were interviewed and the obtained data were analyzed using the Content Analysis Technique. The following categories were discussed based on the references of participative management and planned changes: favorable aspects for the implementation; unfavorable aspects for the implementation; and expectations regarding the implementation. According to the nurses' perceptions, the preliminary use of the electronic system allowed them to show their potential and to propose improvements, encouraging them to become partners of the group manager in the dissemination to other nurses of the institution.

LALP: a language to program custom FPGA-based acceleration engines

Field-Programmable Gate Arrays (FPGAs) are becoming increasingly important in embedded and high-performance computing systems. They allow performance levels close to the ones obtained with Application-Specific Integrated Circuits, while still keeping design and implementation flexibility. However, to efficiently program FPGAs, one needs the expertise of hardware developers in order to master hardware description languages (HDLs) such as VHDL or Verilog. Attempts to furnish a high-level compilation flow (e.g., from C programs) still have to address open issues before broader efficient results can be obtained. Bearing in mind an FPGA available resources, it has been developed LALP (Language for Aggressive Loop Pipelining), a novel language to program FPGA-based accelerators, and its compilation framework, including mapping capabilities. The main ideas behind LALP are to provide a higher abstraction level than HDLs, to exploit the intrinsic parallelism of hardware resources, and to allow the programmer to control execution stages whenever the compiler techniques are unable to generate efficient implementations. Those features are particularly useful to implement loop pipelining, a well regarded technique used to accelerate computations in several application domains. This paper describes LALP, and shows how it can be used to achieve high-performance computing solutions.