Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015

Dose-Adjusted Beta-Lactam Antibiotic-Induced Encephalopathy in a Patient with End-Stage Renal Impairment: A Case Report

Introduction: Despite adherence to current guidelines regarding dose adjustment and drug-level monitoring, beta-lactam-induced encephalopathy can still occur in the setting of chronic renal impairment. Case Report: We report what we believe is the first case of piperacillin- and tazobactam-induced encephalopathy in a patient with pre-existing cefepime-induced encephalopathy in the context of end-stage kidney disease despite adequate dose adjustment for renal impairment.

RELAÇÃO ENTRE O TEOR ABSOLUTO E RELATIVO DE CLOROFILA EM FOLHAS DE VIMEIRO

Os métodos tradicionais para a quantificação de clorofilas implicam na destruição das folhas, além de serem demorados e dispendiosos. Uma alternativa aos métodos destrutivos é o uso de medidores portáteis, dentre eles o SPAD 502, que mede a intensidade da cor verde das folhas, resultando no índice SPAD (Soil Plant Analysis Development). No entanto, o índice SPAD deve ser ajustado para o teor de clorofilas, conforme a espécie de interesse. O objetivo do presente trabalho foi calibrar o índice SPAD para a quantificação de clorofilas em folhas de plantas de vime ( Salix viminalis ). Folhas desta espécie, com tonalidade variando de verde-amarelada (clorótica) a verde-escura, foram avaliadas individualmente com o SPAD-502, seguido de quantificações destrutivas dos teores de clorofilas a, b e totais, expressos em unidade de área e massa fresca foliar. Houve elevado coeficiente de determinação (R²) entre os valores de índice SPAD e os teores de clorofila a, b e totais nas folhas, expressos em μg cm-2 de área foliar (R² de 0,86; 0,88 e 0,93, respectivamente) e entre os valores de índice SPAD e os teores de clorofilas b e totais, expressos em μg g-1 de massa fresca (R² 0,79 e 0,81, respectivamente). Os resultados mostram que existe viabilidade no uso do clorofilômetro SPAD 502, como alternativa aos métodos destrutivos, para a quantificação de clorofilas (em unidade de área; μg cm-2) em folhas de vimeiro.

Crocin and β-Carotene bleaching assays as analytical tools in the optimization of the extraction of hydrophilic and lipophilic antioxidants from tomato

Tomato (Lycopersicon esculentum Mill.) is the second most important vegetable crop worldwide and a rich source of hydrophilic (H) and lipophilic (L) antioxidants. The H fraction is constituted mainly by ascorbic acid and soluble phenolic compounds, while the L fraction contains carotenoids (mostly lycopene), tocopherols, sterols and lipophilic phenolics [1,2]. To obtain these antioxidants it is necessary to follow appropriate extraction methods and processing conditions. In this regard, this study aimed at determining the optimal extraction conditions for H and L antioxidants from a tomato surplus. A 5-level full factorial design with 4 factors (extraction time (I, 0-20 min), temperature (T, 60-180 •c), ethanol percentage (Et, 0-100%) and solid/liquid ratio (S/L, 5-45 g!L)) was implemented and the response surface methodology used for analysis. Extractions were carried out in a Biotage Initiator Microwave apparatus. The concentration-time response methods of crocin and P-carotene bleaching were applied (using 96-well microplates), since they are suitable in vitro assays to evaluate the antioxidant activity of H and L matrices, respectively [3]. Measurements were carried out at intervals of 3, 5 and 10 min (initiation, propagation and asymptotic phases), during a time frame of 200 min. The parameters Pm (maximum protected substrate) and V m (amount of protected substrate per g of extract) and the so called IC50 were used to quantify the response. The optimum extraction conditions were as follows: r~2.25 min, 7'=149.2 •c, Et=99.1 %and SIL=l5.0 giL for H antioxidants; and t=l5.4 min, 7'=60.0 •c, Et=33.0% and S/L~l5.0 g/L for L antioxidants. The proposed model was validated based on the high values of the adjusted coefficient of determination (R2.wi>0.91) and on the non-siguificant differences between predicted and experimental values. It was also found that the antioxidant capacity of the H fraction was much higher than the L one.

A randomised controlled trial comparing weight adjusted dose versus fixed dose prophylactic phenylephrine infusion on maintaining systolic blood pressure during caesarean section under spinal anaesthesia.

Background: Spinal anaesthesia is the standard of care for elective caesarean delivery. It has advantages over general anaesthesia. However the sympathetic blockade induced by spinal anaesthesia results in an 80 percent incidence of hypotension without prophylactic management. Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in the parturient. A prophylactic phenylephrine infusion combined with a fluid co-load is proven to be an effective and safe method of maintaining maternal hemodynamic stability. While most published studies have assessed the effectiveness of a prophylactic phenylephrine fixed dose infusion, few studies have assessed the effect of a prophylactic phenylephrine weight adjusted dose infusion on maintaining maternal hemodynamic stability following spinal anesthesia for a cesarean delivery. Objective: To compare the incidence of hypotension between women undergoing elective caesarean section under spinal anaesthesia, receiving prophylactic phenylephrine infusion at a fixed dose of 37.5 micrograms per minute versus a weight adjusted dose of 0.5 micrograms per kilogram per minute. Methods: One hundred and eight patients scheduled for non-urgent caesarean section under spinal anaesthesia were randomized into 2 groups; control group and intervention group using a computer generated table of numbers. Control group; Received prophylactic phenylephrine fixed dose infusion at 37.5 micrograms per minute. Intervention group; Received prophylactic phenylephrine weight adjusted dose infusion at 0.5 micrograms per kilogram per minute Results: The two groups had similar baseline characteristics in terms of ; Age, sex, weight and height. There was a 35.2% incidence of hypotension in the fixed dose group and an 18.6% incidence of hypotension in the weight adjusted dose group. This difference was found to be of borderline statistical significance p-value 0.05, and the difference in the incidence rates between the two groups was found to be statistically significant p= 0.03. The difference in the incidence of reactive hypertension and bradycardia between the two groups was not statistically significant: p-value of 0.19 for reactive hypertension and p-value of 0.42 for the incidence of bradycardia. There was also no statistically significant difference in the use of phenylephrine boluses, use of atropine, intravenous fluid used and the number of times the infusion was stopped. Conclusion: Among this population, the incidence of hypotension was significantly less in the weight adjusted dose group than in the fixed dose group. There was no difference in the number of physician interventions required to keep the blood pressure within 20% of baseline, and no difference in the proportion of reactive hypertension or bradycardia between the two groups. Administering prophylactic phenylephrine infusion at a weight adjusted dose of 0.5 micrograms per kilogram per minute results in a lower incidence of hypotension compared to its administration at a fixed dose of 37.5 micrograms per minute.

Biomechanical and morphological adaptations in women during pregnancy and the postpartum period in walking

A gravidez é uma fase especial da vida, com diversas alterações nos sistemas hormonais, anatómicos, e na composição corporal da mulher. No entanto, não é claro que alterações biomecânicas tridimensionais ocorrerem. Através do acompanhamento da mulher na gravidez e pós-parto, os objetivos da presente tese foram: 1) determinar os parâmetros temporais e espaciais do ciclo da marcha; 2) descrever a cinemática angular do membro inferior; 3) calcular os momentos e potências articulares do tornozelo, joelho e coxofemoral, utilizando o cálculo por dinâmica inversa; 4) descrever as magnitudes dos picos dos momentos e potências articulares dos membros inferiores; 5) identificar possíveis diferenças entre as fases de recolha relativamente aos parâmetros biomecânicos; 6) descrever longitudinalmente a composição corporal as alterações morfológicas; 7) analisar a influência das alterações antropométricas na cinética articular. Os resultados mostram que as mulheres mantêm os parâmetros temporais e espaciais da marcha. A cinemática angular do membro inferior tem o mesmo padrão, no entanto, a magnitude de alguns picos, especialmente na bacia e coxofemoral durante a fase terminal do apoio, pré-balanço e de balanço, apresentam alterações significativas. A coxofemoral é a articulação com mais alterações na cinética articular, com um aumento da carga interna associada aos momentos articulares da coxofemoral no plano transversal. No entanto, diversos momentos e potências articulares revelam uma diminuição significativa para o final da gravidez e/ou um aumento entre alguns trimestres da gravidez e o pós-parto. Como esperado, a maioria das variáveis associadas à composição corporal e às dimensões corporais tem um aumento significativo durante a gravidez e uma diminuição no pós-parto. Os modelos desenvolvidos para prever a carga interna aplicada ao membro inferior da grávida através de variáveis antropométricas, incluem quatro modelos com variáveis associadas à quantidade de gordura, quatro modelos com variáveis associadas à massa corporal global, três modelos que incluem a massa livre de gordura, e um modelo que inclui a forma do tronco. Os altos valores do R2 ajustado, mostram que as alterações na composição corporal e morfologia, determinam em grande parte a cinética articular da mulher nesta fase particular da vida.

Comparison between benzyladenine and metamitron as chemical thinning agents in Gala, Kanzi, Pink Lady and Red Delicious apple cultivars

Mestrado em Engenharia Agronómica - Instituto Superior de Agronomia - UL

Le mode de ventilation neurally adjusted ventilatory assist (NAVA) est faisable, bien toléré, et permet la synchronie entre le patient et le ventilateur pendant la ventilation non invasive aux soins intensifs pédiatriques : étude physiologique croisée

Introduction: La ventilation non invasive (VNI) est un outil utilisé en soins intensifs pédiatriques (SIP) pour soutenir la détresse respiratoire aigüe. Un échec survient dans près de 25% des cas et une mauvaise synchronisation patient-ventilateur est un des facteurs impliqués. Le mode de ventilation NAVA (neurally adjusted ventilatory assist) est asservi à la demande ventilatoire du patient. L’objectif de cette étude est d’évaluer la faisabilité et la tolérance des enfants à la VNI NAVA et l’impact de son usage sur la synchronie et la demande respiratoire. Méthode: Étude prospective, physiologique, croisée incluant 13 patients nécessitant une VNI dans les SIP de l’hôpital Ste-Justine entre octobre 2011 et mai 2013. Les patients ont été ventilés successivement en VNI conventionnelle (30 minutes), en VNI NAVA (60 minutes) et en VNI conventionnelle (30 minutes). L’activité électrique du diaphragme (AEdi) et la pression des voies aériennes supérieures ont été enregistrées pour évaluer la synchronie. Résultats: La VNI NAVA est faisable et bien tolérée chez tous les enfants. Un adolescent a demandé l’arrêt précoce de l’étude en raison d’anxiété reliée au masque sans fuite. Les délais inspiratoires et expiratoires étaient significativement plus courts en VNI NAVA comparativement aux périodes de VNI conventionnelle (p< 0.05). Les efforts inefficaces étaient moindres en VNI NAVA (résultats présentés en médiane et interquartiles) : 0% (0 - 0) en VNI NAVA vs 12% (4 - 20) en VNI conventionnelle initiale et 6% (2 - 22) en VNI conventionnelle finale (p< 0.01). Globalement, le temps passé en asynchronie a été réduit à 8% (6 - 10) en VNI NAVA, versus 27% (19 - 56) et 32% (21 - 38) en périodes de VNI conventionnelle initiale et finale, respectivement (p= 0.05). Aucune différence en termes de demande respiratoire n’a été observée. Conclusion: La VNI NAVA est faisable et bien tolérée chez les enfants avec détresse respiratoire aigüe et permet une meilleure synchronisation patient-ventilateur. De plus larges études sont nécessaires pour évaluer l’impact clinique de ces résultats.

Le mode de ventilation neurally adjusted ventilatory assist (NAVA) est faisable, bien toléré, et permet la synchronie entre le patient et le ventilateur pendant la ventilation non invasive aux soins intensifs pédiatriques : étude physiologique croisée

Introduction: La ventilation non invasive (VNI) est un outil utilisé en soins intensifs pédiatriques (SIP) pour soutenir la détresse respiratoire aigüe. Un échec survient dans près de 25% des cas et une mauvaise synchronisation patient-ventilateur est un des facteurs impliqués. Le mode de ventilation NAVA (neurally adjusted ventilatory assist) est asservi à la demande ventilatoire du patient. L’objectif de cette étude est d’évaluer la faisabilité et la tolérance des enfants à la VNI NAVA et l’impact de son usage sur la synchronie et la demande respiratoire. Méthode: Étude prospective, physiologique, croisée incluant 13 patients nécessitant une VNI dans les SIP de l’hôpital Ste-Justine entre octobre 2011 et mai 2013. Les patients ont été ventilés successivement en VNI conventionnelle (30 minutes), en VNI NAVA (60 minutes) et en VNI conventionnelle (30 minutes). L’activité électrique du diaphragme (AEdi) et la pression des voies aériennes supérieures ont été enregistrées pour évaluer la synchronie. Résultats: La VNI NAVA est faisable et bien tolérée chez tous les enfants. Un adolescent a demandé l’arrêt précoce de l’étude en raison d’anxiété reliée au masque sans fuite. Les délais inspiratoires et expiratoires étaient significativement plus courts en VNI NAVA comparativement aux périodes de VNI conventionnelle (p< 0.05). Les efforts inefficaces étaient moindres en VNI NAVA (résultats présentés en médiane et interquartiles) : 0% (0 - 0) en VNI NAVA vs 12% (4 - 20) en VNI conventionnelle initiale et 6% (2 - 22) en VNI conventionnelle finale (p< 0.01). Globalement, le temps passé en asynchronie a été réduit à 8% (6 - 10) en VNI NAVA, versus 27% (19 - 56) et 32% (21 - 38) en périodes de VNI conventionnelle initiale et finale, respectivement (p= 0.05). Aucune différence en termes de demande respiratoire n’a été observée. Conclusion: La VNI NAVA est faisable et bien tolérée chez les enfants avec détresse respiratoire aigüe et permet une meilleure synchronisation patient-ventilateur. De plus larges études sont nécessaires pour évaluer l’impact clinique de ces résultats.

Iowa's Budget Report, Fiscal Year 2018-2019 Include Adjusted Fiscal Year 2017, January 10, 2017

This document summarizes Governor Terry E. Branstad's Program and Budget Recommendations for the General Assembly

Program and Budget Fiscal Years 2018-2019 Includes Adjusted Fiscal Year 2017, January 10, 2017

This document summarizes Governor Terry E. Branstad's Program and Budget Recommendations for the General Assembly

Seasonal dynamics and operational monitoring of hedgerow olive tree transpiration in response to applied water

We used 2012 sap flow measurements to assess the seasonal dynamics of daily plant transpiration (ETc) in a high-density olive orchard (Olea europaea L. cv. ‘Arbequina’) with a well-watered (HI) control treatment A to supply 100 % of the crop water needs, and a moderately (MI) watered treatment B that replaced 70% of crop needs. To assure that treatment A was well-watered, we compared field daily ETc values against ETc obtained with the Penman-Monteith (PM) combination equation incorporating the Orgaz et al. (2007) bulk daily canopy conductance (gc) model, validated for our non-limiting conditions. We then tested the hypothesis of indirectly monitoring olive ETc from readily available vegetation index (VI) and ground-based plant water stress indicator. In the process we used the FAO56 dual crop coefficient (Kc) approach. For the HI olive trees we defined Kcb as the basal transpiration coefficient, and we related Kcb to remotely sensed Soil Adjusted Vegetation Index (SAVI) through a Kcb-SAVI functional relationship. For the MI treatment, we defined the actual transpiration ETc as the product of Kcb and the stress reduction coefficient Ks obtained as the ratio of actual to crop ETc, and we correlated Ks with MI midday stem water potential (ψst) values through a Ks-ψ functional relationship. Operational monitoring of ETc was then implemented with the ETc = Kcb(SAVI)Ks(ψ)ETo relationship stemmed from the FAO56 approach and validated taking as inputs collected SAVI and ψst data reporting to year 2011. Low validation error (6%) and high goodness-of-fit of prediction were observed (R2 = 0.94, RSME = 0.2 mm day-1, P = 0.0015), allowing to consider that under field conditions it is possible to predict ETc values for our hedgerow olive orchards if SAVI and water potential (ψst) values are known.

Is the maximum velocity of carboxylation (Vcmax) well adjusted for deciduous shrubs in DGVMs: a case study for the Caatinga Biome in Brazil.

Vcmax is the rate of maximum velocity of carboxylation of plants and is considered one of the most critical parameters for changes in vegetation in face of global changes and it has a direct impact on gross primary productivity. Physiological processes are considered the main sources of uncertainties in dynamic global vegetation models (DGVMs). The Caatinga biome, in the semiarid region of northeastern Brazil, is extremely important due to its biodiversity and endemism. In a field work realized in an area of preserved Caatinga forest, measurements of carbon assimilation (in response to light and CO2) were performed on 11 individuals of a native species. These results of Vcmax measurements in Caatinga were compared with parameterization of models, revealing that Vcmax is not well adjusted in several DGVMs. Also, the values obtained in the Caatinga field experiments were very close to empirical values obtained in the Northern hemisphere (Austria). These ecophysiological measurements can contribute in understanding of this biome