Clinical aspects of gestational trophoblastic disease: A review based partly on 25-year experience of a statewide registry

Background: Gestational trophoblastic disease is a fascinating group of pregnancy disorders characterised by abnormal proliferation of trophoblast, ranging from benign to malignant. Because the disease is uncommon, there is a need to formulate management with the assistance of collective information. Methodology: A review of available information from English written literature was undertaken especially data reported by registries around the world (Charing Cross Hospital in England, the North-western University and the New England area in the USA as well as our own experience in Queensland, Australia). Where possible, collated data from relevant studies were analysed to answer some of the questions posed in clinical practice, with reference to metastatic disease to liver and brain, twinning of molar gestation and coexisting fetus, and placental-site tumour. Results: We found that molar gestation can be classified according to its clinical presentation which influences the time taken to reach human chorionic gonadotropin (HCG) 'negativity' and the risk of persisting disease. Categorisation of risk is the basis for choice of chemotherapy to achieve good outcomes. Metastases to liver and brain remain problems in management; the development of 'new' metastases during chemotherapy is a very poor prognostic factor. In the variant of twinning with molar gestation and coexisting fetus, it is important to elucidate the fetal karyotype in planning management: a 69XXX fetus is not salvageable but a normal 46XX or 46XY fetus faces the prospect of early preterm delivery. The placental-site tumour is very rare; localised disease is curable by surgery; chemotherapy is less effective in disseminated disease. From collated worldwide data, the recurrence rate after one mole is 1.3% and after two or more is 20%. Reproductive outcome in subsequent pregnancies, even after multidrug chemotherapy, is not different from the general population. Because of the increased risk long-term of second tumours after multidrug chemotherapy a closer surveillance of these patients is necessary Conclusion: In general, the disease in its persisting or malignant form is 'a cancer model par excellence' because of an identifiable precursor condition, a reliable HCG marker, and sensitivity of the disease to cytotoxic drugs. With current management, retention of fertility is possible and normal reproductive outcome assured.

'Suitable mothers': lesbian and single women and the 'unborn' in Australian parliamentary discourse

Throughout the latter months of 2000 and early 2001, the Australian public, media and parliament were engaged in a long and emotive debate about motherhood. This debate constructed the two main protagonists, the unborn 'child' and the potential mother, with a variety of different and often oppositional identities. The article looks at the way that these subject identities interacted during the debate, starting from the premise that policy making has unintended and unacknowledged material outcomes, and using governmentality as a tool through which to analyse and understand processes of identity manipulation and resistance within policy making. The recent debate concerning the right of lesbian and single women to access new reproductive technologies in Australia is used as a case study. Nominally the debate was about access to IVF technology; in reality, however, the debate was about the governing of women and, in particular, the governing of motherhood identities. The article focuses on the parliamentary debate over the drafting of legislation designed to stop lesbian and single women from accessing these technologies, particularly the utilization of the 'unborn' subject within these debates as a device to discipline the identity of 'mother'.

Low temperature induced spikelet sterility in rice. I. Nitrogen fertilisation and sensitive reproductive period

Low temperature during panicle development in rice increases spikelet sterility. This effect is exacerbated by high rates of nitrogen (N) application in the field. Spikelet sterility induced by low temperature and N fertilisation was examined in glasshouse experiments to clarify the mechanisms involved. In two glasshouse experiments, 12-h periods of low (18/13degreesC) and high (28/23degreesC) day/night temperatures were imposed over periods of 5-7 days during panicle development, to determine the effects of low temperature and N fertilisation on spikelet sterility. In one experiment, 50% sunlight was imposed together with low temperature to investigate the additive effects of reduced solar radiation and low temperature. The effect of increased tillering due to N fertilisation was examined by a tiller removal treatment in the same experiment. Pollen grain number and spikelet sterility were recorded at heading and harvest, respectively. Although there was no significant effect of low temperature on spikelet sterility in the absence of applied N, low temperature greatly increased spikelet sterility as a result of a reduction in the number of engorged pollen grains per anther in the presence of applied N. Spikelet sterility was strongly correlated with the number of engorged pollen grains per anther. Low temperature during very early ( late stage of spikelet differentiation-pollen mother cell stage) and peak ( second meiotic division stage-early stage of extine formation) microspore development caused a severe reduction in engorged pollen production mainly as a result of reduced total pollen production. Unlike low temperature, the effect of shading was rather small. The increased tillering due to application of high rates of N, increased both spikelet number per plant and spikelet sterility under low temperature conditions. The removal of tillers as they appeared reduced the number of total spikelets per plant and maintained a large number of engorged pollen grains per anther which, in turn, reduced spikelet sterility. The number of engorged pollen grains per anther determined the numbers of intercepted and germinated pollen grains on the stigma. It is concluded that N increased tillering and spikelet number per plant and this, in turn, reduced the number of engorged pollen grains per anther, leading into increased spikelet sterility under low temperature condition.

Electronic government policies in Brazil: context, ICT management and outcomes

The State Reform processes combined with the emergence and use of Information and Communication Technology (ICT) originated electronic government policies and initiatives in Brazil. This paper dwells on Brazilian e-government by investigating the institutional design it assumed in the state's public sphere, and how it contributed to outcomes related to e-gov possibilities. The analyses were carried out under an interpretativist perspective by making use of Institutional Theory. From the analyses of interviews with relevant actors in the public sphere, such as state secretaries and presidents of public ICT companies, conclusions point towards low institutionalization of e-gov policies. The institutional design of Brazilian e-gov limits the use of ICT to provide integrated public services, to amplify participation and transparency, and to improve public policies management.

COGNITIVE LEGITIMACY, RESOURCE ACCESS, AND ORGANIZATIONAL OUTCOMES

Previous research has demonstrated the importance of developing legitimacy initiatives in order to create new business opportunities, satisfy shareholders, and obtain access to resources. Within this framework, cognitive legitimacy plays a key role. Through a case study of six Spanish public universities, the authors measure the relationship between cognitive legitimacy, access to resources, and organizational results. The results support the assertion that organizations with more cognitive legitimacy have greater access to resources and improved their results. This study contributes with muchneeded empirical research on cognitive legitimacy and demonstrates its usefulness as an explanative factor of organizational success.

Predictors of Successful Weight Control: Cross-Cultural Moderators of Treatment Outcomes

Given the heterogeneity of effect sizes within the population for any treatment, identifying moderators of outcomes is critical [1]. In weight management programs, there is a high individual variability in terms of weight loss and an overall modest success [2]. Some people will adopt and sustain attitudes and behaviors associated with weight loss, while others won’t [3]. To predict weight loss outcome just from the subject’s baseline information would be very valuable [4,5]. It would allow to: - Better match between treatments and individuals - Identify the participants with less probability of success (or potential dropouts) in a given treatment and direct them to alternative therapies - Target limited resources to those most likely to succeed - Increase cost-effectiveness and improve success rates of the programs Few studies have been dedicated to describe baseline predictors of treatment success. The Healthy Weight for Life (USA) study is one of the few. Its findings are now being cross-validated in Portuguese samples. This paper describes these cross-cultural comparisons.

Nutritional status of pregnant women: prevalence and associated pregnancy outcomes

INTRODUCTION: Although obesity is well recognized as a current public health problem, its prevalence and impact among pregnant women have been less investigated in Brazil. The objective of the study was to evaluate the impact of pre-obesity and obesity among pregnant women, describing its prevalence and risk factors, and their association with adverse pregnancy outcomes. METHODS: A cohort of 5,564 pregnant women, aged 20 years or more, enrolled at aproximately 20 to 28 weeks of pregnancy, seen in prenatal public clinics of six state capitals in Brazil were followed up, between 1991 and 1995. Prepregnancy weight, age, educational level and parity were obtained from a standard questionnaire. Height was measured in duplicate and the interviewer assigned the skin color. Nutritional status was defined using body mass index (BMI), according to World Health Organization (WHO) criteria. Odds ratios and 95% confidence interval were calculated using logistic regression. RESULTS: Age-adjusted prevalences (and 95% CI) based on prepregnancy weight were: underweight 5.7% (5.1%-6.3%), overweight 19.2% (18.1%-20.3%), and obesity 5.5% (4.9%-6.2%). Obesity was more frequently observed in older black women, with a lower educational level and multiparous. Obese women had higher frequencies of gestational diabetes, macrosomia, hypertensive disorders, and lower risk of microsomia. CONCLUSIONS: Overweight nutritional status (obesity and pre-obesity) was seen in 25% of adult pregnant women and it was associated with increased risk for several adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia.

Radiographic outcomes and evaluation of developmental dysplasia of the hip in children

The Developmental Dysplasia of the Hip (DDH), also know as Congenital Dislocation of the Hip, is common in infants and children and may persist into adulthood. The radiographic interpretation is highly conditioned by appropriate patient positioning and image quality criteria. The main goal of this study is to demonstrate the value of radiographic evaluation of DDH. Through the retrospective analysis of 65 radiographs of the hips, only 2 (3.1%) female patients with 1-2 years of age presented radiographic findings of DDH. The inappropriate field size and the improper placement and size of the gonadal shields, were the most common errors observed.

Temporal variation in reproductive phenology of Patella spp.: past and present.

World Congress of Malacology, Universidade dos Açores, Ponta Delgada, 21-28 de julho.

Reproductive dynamics of Sterna hirundinacea Lesson, 1831 in Ilha dos Cardos, Santa Catarina, Brazil

In this work, we intend to describe the reproductive dynamics of Sterna hirundinacea in an island fromSouth Brazil.We studied the reproductive biology of this species in its natural environment and provide data on their growth, survival, and reproductive success in Ilha dosCardos, SantaCatarina, South Brazil. Samplingswere carried out daily on the island throughout the reproductive seasons of 2003, 2005, and 2006 and the different stages of development of the chicks were characterized according to age, length of the beak, and plumage characteristics.We provide a basic equation Lm = 167.91 (1 – e −0.062t−(−0.23)) to determine the approximate age of individuals using their body mass. The main cause of chick mortality on the island was natural (63.17% in 2003, 81.41% in 2005, and 79.96% in 2006), whereas predation contributed to mortality in a proportion of 38.83% in 2003, 18.59% in 2005, and 20.04% in 2006.The absence in the area of the chicks’ main predator, Kelp gull (Larus dominicanus), the large number of chicks that reached the final stages of development, and their reproductive success demonstrate that Ilha dos Cardos is an important breeding site for the species in southern Brazil.

Treatment outcomes in pulmonary tuberculosis and associated factors worldwide: a systematic review and meta-analysis

Introduction - The increasing of TB burden is usually related to inadequate case detection, diagnosis and cure. Global targets for TB control, adopted by the World Health Organization (WHO), are to detect 70% of the estimated incidence of sputum smear-positive TB and to cure 85% of newly detected cases of sputum smear-positive TB. Factors associated with unsuccessful treatment outcomes are closely related to TB risk factors. Objectives - To describe treatment success rates in pulmonary TB cases and to identify factors associated with unsuccessful treatment outcomes, according to ad-hoc studies.

Pittosporum Undulatum and Hedychium Gardnerianum: nutritive value and secondary metabolites on cattle reproductive performances

Hedychium gardnerianum (HG) and Pittospporum undulatum (PU) are invasive plants all over the world, being in the Azores supplied to cattle on periods of shortage food. As these plants produce secondary metabolites, including a diverse range of phytochemicals compounds, the aim of the presente study is to identify how these metabolites can be related to animal’s reproductive performances. For such purpose, plants were harvested on winter, compounds extracted by method of decoction and analysed by combination of liquid chromatography and mass spectrometry as well as highperformance liquid chromatography. For nutritive evaluations, Van Soest and Weende methodologies were used. In HG quercetin-3, 4'-di-O-betaglucopyranoside, myricetin rhamnoside, quercetin rhamnoside, and gibberellin A1 and A8 were identified, while for PU were found cafeic acid derivatives, including dicaffeoylquinic acid and caffeoylquinic acid. In nutritional terms, these plants can be considered as poor, presenting percentages of dry matter (DM%) of 16.34% and 40.39%, respectively for HG and PU. Values for ash 10.4%, crude protein (CP) 7.75%, neutral detergent fiber (NDF) 64.5, acid detergent fiber (ADF) 34.69%, acid detergent lignin (ADL) 3.47% and ether extract (EE) 2.03% were found for HG. For PU values were ash 6.64%, CP 6.11%, NDF 43.84%, acid ADF 35.57%, ADL 3.56% and EE 2.71%. This study clearly indicated that, besides their low nutritive values, these plants can be used to feed ruminants, especially when pasture lacks. Nevertheless, as some compounds, namely the caffeoylquinic and dicaffeoylquinic acids, are known to be associated to physiological reproductive mechanisms, one could speculate that these compounds can be directly or indirectly associated to reproductive performances in bovine fed with these plants.

Physical activity during pregnancy and fetal outcomes: a case-control study

OBJECTIVE: To investigate the relationship between physical activity during the second trimester pregnancy and low birth weight, preterm birth, and intrauterine growth restriction. METHODS: Case-control study including 273 low birth weight newborns and 546 controls carried out in the city of São Paulo, Southeastern Brazil, in 2005. Low birth weight cases were grouped into two subsamples: preterm birth (n=117) and intrauterine growth restriction (n=134), with their related controls. Information was collected by means of interviews with mothers shortly after birth and transcription of medical records. Data were analyzed using conditional multiple and hierarchical logistic regression. RESULTS: Light physical activity for over 7 hours per day was shown to be protective against low birth weight (adjusted OR=0.61; 95% CI 0.39-0.94) with a dose-response relationship (p-value for trend=0.026). A similar trend was found for intrauterine growth restriction (adjusted OR=0.51; 95% CI 0.26-0.97). Homemaking activities were associated as a protective factor for both low birth weight and preterm birth (p-value for trend=0.013 and 0.035, respectively). Leisure-time walking was found to be protective against preterm birth. CONCLUSIONS: Mild physical activity during the second trimester of pregnancy such as walking has an independent protective effect on low birth weight, preterm birth, and intrauterine growth restriction.

Defining and Classifying Learning Outcomes: A case study

Bologne came to globalize education in higher education, creating a unified architecture that potentiates higher education and enhances the continued interconnection of the spaces of education policy in higher education in the world, in particular in Europe. The aim of this work consists in the presentation of an identification model and skills’ classification and learning outcomes, based on the official documents of the course units (syllabus and assessment components) of a course of Higher Education. We are aware that the adoption of this model by different institutions, will contribute to interoperability learning outcomes, thus enhancing the mobility of teachers and students in the EHEA (European Higher Education Area) and third countries.

Payment for performance in the Family Health Programme: lessons from the UK Quality and Outcomes Framework

OBJECTIVE: Payment for performance financial incentive schemes reward doctors based on the quality and the outcomes of their treatment. In Brazil, the Ministry of Health is looking to scale up its use in public hospitals and some municipalities are developing payment for performance schemes even for the Family Health Programme. In this article the Quality and Outcomes Framework used in the UK since 2004 is discussed, as well as its experience to elaborate some important lessons that Brazilian municipalities should consider before embarking on payment for performance scheme in primary care settings.