Elevation of Uterine Basal Tone and Fetal Heart Rate Abnormalities After Labor Analgesia A Randomized Controlled Trial

OBJECTIVE: To estimate the effects of combined spinal-epidural and traditional epidural analgesia on uterine basal tone and its association with the occurrence of fetal heart rate (FHR) abnormalities. METHODS: Seventy-seven laboring patients who requested pain relief during labor were randomly assigned to combined spinal-epidural (n=41) or epidural analgesia (n=36). Uterine contractions and FHR were recorded 15 minutes before and after analgesia. Uterine tone was evaluated with intrauterine pressure catheter. Primary outcomes were the elevation of baseline uterine tone and occurrence of FHR prolonged decelerations or bradycardia after analgesia. The influence of other variables such as oxytocin use, hypotension, and speed of pain relief were estimated using a logistic regression model. RESULTS: The incidence of all outcomes was significantly greater in the combined spinal-epidural group compared with epidural: uterine hypertonus (17 compared with 6; P=.018), FHR abnormalities (13 compared with 2; P<.01), and both events simultaneously (11 compared with 1; P<.01). Logistic regression analysis showed the type of analgesia as the only independent predictor of uterine hypertonus (odds ratio 3.526, 95% confidence interval 1.21-10.36; P=.022). For the occurrence of FHR abnormalities, elevation of uterine tone was the independent predictor (odds ratio 18.624, 95% confidence interval 4.46-77.72; P<.001). Regression analysis also found a correlation between decrease on pain scores immediately after analgesia and the estimated probability of occurrence of hypertonus and FHR abnormalities. CONCLUSION: Combined spinal-epidural analgesia is associated with a significantly greater incidence of FHR abnormalities related to uterine hypertonus compared with epidural analgesia. The faster the pain relief after analgesia, the higher the probability of uterine hypertonus and FHR changes. CLINICAL TRIAL REGISTRATION: Umin Clinical Trials Registry, http://www.umin.ac.jp/ctr/index.htm, UMIN000001186

Riddling and invariance for discontinuous maps preserving Lebesgue measure

In this paper we use the mixture of topological and measure-theoretic dynamical approaches to consider riddling of invariant sets for some discontinuous maps of compact regions of the plane that preserve two-dimensional Lebesgue measure. We consider maps that are piecewise continuous and with invertible except on a closed zero measure set. We show that riddling is an invariant property that can be used to characterize invariant sets, and prove results that give a non-trivial decomposion of what we call partially riddled invariant sets into smaller invariant sets. For a particular example, a piecewise isometry that arises in signal processing (the overflow oscillation map), we present evidence that the closure of the set of trajectories that accumulate on the discontinuity is fully riddled. This supports a conjecture that there are typically an infinite number of periodic orbits for this system.

Multiple maps and activity-dependent representational plasticity in the anterior Wulst of the adult barn owl (Tyto alba)

In the present study we addressed the issue of somatosensory representation and plasticity in a nonmammalian species, the barn owl. Multiunit mapping techniques were used to examine the representation of the specialized receptor surface of the claw in the anterior Wulst. We found dual somatotopic mirror image representations of the skin surface of the contralateral claw. In addition, we examined both representations 2 weeks after denervation of the distal skin surface of a single digit. In both representations, the denervated digital representation became responsive to stimulation of the adjacent, mutually functional, digit. The mutability and multiple representations indicates that the Wulst provides the owl with sensory processing capabilities analogous to those in mammals.

Pseudo-randomness of round-off errors in discretized linear maps on the plane

We analyze the sequences of round-off errors of the orbits of a discretized planar rotation, from a probabilistic angle. It was shown [Bosio & Vivaldi, 2000] that for a dense set of parameters, the discretized map can be embedded into an expanding p-adic dynamical system, which serves as a source of deterministic randomness. For each parameter value, these systems can generate infinitely many distinct pseudo-random sequences over a finite alphabet, whose average period is conjectured to grow exponentially with the bit-length of the initial condition (the seed). We study some properties of these symbolic sequences, deriving a central limit theorem for the deviations between round-off and exact orbits, and obtain bounds concerning repetitions of words. We also explore some asymptotic problems computationally, verifying, among other things, that the occurrence of words of a given length is consistent with that of an abstract Bernoulli sequence.

Como lidar com a nova geração de administradores: os baby busters

Jovens empregados valorizam mais desafios e crescimento pessoal do que dinheiro e status - estão remodelando os padrões de RH.

Pagamento de proventos versus preços deações maduras e em expansão segundo Kohonen Maps

Este estudo investiga se a política de distribuição de resultados seria capaz de alterar os preços das ações de uma empresa. O objetivo deste trabalho é discutir os impactos do pagamento de proventos sobre os preços das ações, na data ex direito, de empresas maduras e de empresas em expansão, considerando-se ainda o efeito da classe da ação (ordinária ou preferencial) sobre os resultados. Para tal, adotou-se a metodologia de dados em painel, segmentando a amostra a partir dos Mapas Auto-organizáveis de Kohonen. Os resultados revelam que a estratégia de curto prazo de comprar ações na última data com, vender na primeira data ex e embolsar os dividendos é capaz de gerar perdas de capital que superam em até quatro vezes o ganho líquido decorrente do provento embolsado.

Toplological Entropy in the Syncronization of Piecewise Linear and Monotone Maps. Coupled Duffing Oscillators

In this paper is presented a relationship between the synchronization and the topological entropy. We obtain the values for the coupling parameter, in terms of the topological entropy, to achieve synchronization of two unidirectional and bidirectional coupled piecewise linear maps. In addition, we prove a result that relates the synchronizability of two m-modal maps with the synchronizability of two conjugated piecewise linear maps. An application to the unidirectional and bidirectional coupled identical chaotic Duffing equations is given. We discuss the complete synchronization of two identical double-well Duffing oscillators, from the point of view of symbolic dynamics. Working with Poincare cross-sections and the return maps associated, the synchronization of the two oscillators, in terms of the coupling strength, is characterized.

In permanent transit: discourses and maps of the intercultural experience

Instituto Politécnico do Porto. Instituto Superior de Contabilidade e Administração do Porto

Genus and Braid Index Associated to Sequences of Renormalizable Lorenz Maps

We describe the Lorenz links generated by renormalizable Lorenz maps with reducible kneading invariant (K(f)(-), = K(f)(+)) = (X, Y) * (S, W) in terms of the links corresponding to each factor. This gives one new kind of operation that permits us to generate new knots and links from the ones corresponding to the factors of the *-product. Using this result we obtain explicit formulas for the genus and the braid index of this renormalizable Lorenz knots and links. Then we obtain explicit formulas for sequences of these invariants, associated to sequences of renormalizable Lorenz maps with kneading invariant (X, Y) * (S,W)*(n), concluding that both grow exponentially. This is specially relevant, since it is known that topological entropy is constant on the archipelagoes of renormalization.

Lidar com o sofrimento em Fisioterapia: a experiência formativa na ESTSP-IPP

A comunicação e a relação terapêutica são reconhecidamente domínios de competência dos profissionais de saúde cujas funções impliquem o contacto com doentes (Corney, 2000; Grilo & Pedro, 2005; Pio Abreu, 1998). Além do seu papel determinante na adesão terapêutica, a qualidade da comunicação e da relação terapêutica estabelecida tem particular impacto no sofrimento da pessoa, tomado como constructo multidimensional (McIntyre, 2004). Tradicionalmente descurados na formação académica, estes temas tendem actualmente a ganhar expressão nos currículos, para o que contribuíram, no espaço europeu, as recomendações para a adequação a Bolonha (Lopes, 2004). Neste trabalho, descrevemos a metodologia de formação adoptada para estes domínios na licenciatura em Fisioterapia da ESTSP-IPP, a funcionar segundo o modelo pedagógico designado Problem-Based Learning (Walsh, 2005; Macedo, 2009). Além dos conhecimentos disseminados ao longo de toda a estrutura curricular, temas como a comunicação (Watzlawick, Bavelas & Jackson, 1967/1993), a escuta activa (Gordon & Edwards, 1997), a relação terapêutica (Rogers, 1957/1992, 1980, 1985), as competências e microcompetências/técnicas de atendimento e de observação (Ivey, 1983; Ivey & Downing, 1990; Ivey, Gluckstern & Ivey, 2006) ou as comunicações difíceis (Faulkner, Maguire & Regnard, 1994; Maguire, 2000) são alvo de formação mais intensiva ao longo de cerca de 16 semanas consecutivas do 1º ciclo de estudos, com recurso a diferentes tipologias de aula visando desenvolver, além dos conhecimentos, atitudes e habilidades nestes domínios.