From Underground to Elite: Egyptian Bloggers before and after the 2011 Uprising

This research looks at how the shift in the status of Egyptian bloggers from underground dissident voices to mainstream political and media players affected the plurality they add to the public space for discourse in Egypt’s authoritarian settings. The role of the internet – and more recently social media and bloggers – in democratic transition has been studied by various media scholars since the introduction of the worldwide web and especially after the Egyptian and Tunisian uprisings of 2011. But no work has been done to study how bringing those once-underground bloggers into the public and media spotlight affected the nature of the blogosphere and the bloggers themselves. Star bloggers were not only covered by the media after January 25th, 2011, they also started joining the media as column writers; a move that had various effects on them and the blogosphere but was never examined in media studies. The plurality the blogosphere adds to the Egyptian public space for discourse in light of those changes as well as in light of the financial and practical sustainability of blogging was hence never looked at in a context similar to Egypt’s. Guided by modified theories of the public sphere and theories of hegemony and manufacturing consent, I look at whether bloggers have been co-opted into the historical bloc in the process of renewing the social order and how this affects them and the online sphere. Also, guided by theories of power and media elites, I look at bloggers’ backgrounds to assess whether they come from power elites and are transforming into media elites, thus limiting the plurality of the online sphere. Finally, guided by theoretical works on institutionalizing and commercializing the internet, I look at how those shifts into mainstream affect the independence and freedom of the blogs and microblogs. The research uses a comparative study to assess how those changes affect prominent versus less prominent bloggers and compare their backgrounds. The study uses quantitative content analysis and framing analysis of chosen media outlets and interviews with bloggers, marketeers and media professionals. The findings trace an increase in media coverage of bloggers post January 25th, 2011, especially in the prominent bloggers category, and an overall positive framing of bloggers post the uprising. This led to the mainstreaming of bloggers into the media as well as public work, which had various implications on the freedom they had over their content and voice, both online and offline. It also points to a dramatic decrease in bloggers’ activity on their blogs in favour of mainstream and social media and due to star bloggers becoming more career-oriented and their failure to make blogs financially sustainable. The findings also indicate that more prominent bloggers seem to come from more elite backgrounds than others and enjoy luxuries that allow them the time, technology and security to post online. This research concludes that the shifts in bloggers’ status post-January 25th have limited the plurality they add to the discourse in Egypt.

An Objective Framework to Test the Quality of Candidate Indicators of Good Environmental Status

Large efforts are on-going within the EU to prepare the Marine Strategy Framework Directive’s (MSFD) assessment of the environmental status of the European seas. This assessment will only be as good as the indicators chosen to monitor the eleven descriptors of good environmental status (GEnS). An objective and transparent framework to determine whether chosen indicators actually support the aims of this policy is, however, not yet in place. Such frameworks are needed to ensure that the limited resources available to this assessment optimize the likelihood of achieving GEnS within collaborating states. Here, we developed a hypothesis-based protocol to evaluate whether candidate indicators meet quality criteria explicit to the MSFD, which the assessment community aspires to. Eight quality criteria are distilled from existing initiatives, and a testing and scoring protocol for each of them is presented. We exemplify its application in three worked examples, covering indicators for three GEnS descriptors (1, 5 and 6), various habitat components (seaweeds, seagrasses, benthic macrofauna and plankton), and assessment regions (Danish, Lithuanian and UK waters). We argue that this framework provides a necessary, transparent and standardized structure to support the comparison of candidate indicators, and the decision-making process leading to indicator selection. Its application could help identify potential limitations in currently available candidate metrics and, in such cases, help focus the development of more adequate indicators. Use of such standardized approaches will facilitate the sharing of knowledge gained across the MSFD parties despite context-specificity across assessment regions, and support the evidence-based management of European seas.

An Objective Framework to Test the Quality of Candidate Indicators of Good Environmental Status

Large efforts are on-going within the EU to prepare the Marine Strategy Framework Directive’s (MSFD) assessment of the environmental status of the European seas. This assessment will only be as good as the indicators chosen to monitor the eleven descriptors of good environmental status (GEnS). An objective and transparent framework to determine whether chosen indicators actually support the aims of this policy is, however, not yet in place. Such frameworks are needed to ensure that the limited resources available to this assessment optimize the likelihood of achieving GEnS within collaborating states. Here, we developed a hypothesis-based protocol to evaluate whether candidate indicators meet quality criteria explicit to the MSFD, which the assessment community aspires to. Eight quality criteria are distilled from existing initiatives, and a testing and scoring protocol for each of them is presented. We exemplify its application in three worked examples, covering indicators for three GEnS descriptors (1, 5 and 6), various habitat components (seaweeds, seagrasses, benthic macrofauna and plankton), and assessment regions (Danish, Lithuanian and UK waters). We argue that this framework provides a necessary, transparent and standardized structure to support the comparison of candidate indicators, and the decision-making process leading to indicator selection. Its application could help identify potential limitations in currently available candidate metrics and, in such cases, help focus the development of more adequate indicators. Use of such standardized approaches will facilitate the sharing of knowledge gained across the MSFD parties despite context-specificity across assessment regions, and support the evidence-based management of European seas.

Submission Fees - A Tool in the Transition to Open Access?

Knowledge Exchange examined different routes in achieving the vision of 'having a layer of scholarly and scientific content openly available in the internet'. One of these routes involves exploring new developments in the future of publishing. Work is being undertaken investigating interesting alternative business models which could contribute to the transition to open access. In this light KE has commissioned a study investigating whether submission fees could play a role in a business model for Open Access journals. The general conclusion of the report bearing the title ‘Submission Fees a tool in the transition to open access?', written by Mark Ware, is that there are benefits to publishers in certain cases to switch to a model in which an author pays a fee when submitting an article. Especially journals with a high rejection rate might be interested in combining submission fees with article processing charges in order to make the transition to open access easier. In certain disciplines, notably economic and finance journals and in some areas of the experimental life sciences, submission fees are already common. Overall there seems to be an interest in the model but the risks, particularly those involved in any transition, are seen by the publishers to outweigh the perceived benefits. There is also a problem in that the advantages offered by submission fees are often general benefits that might improve the system but do not provide publishers and authors with direct incentives to change to open access. To support transition funders, institutions and publication funds could make it clear that submission fees would be an allowable cost. At present this is often unclear in their policies. Author acceptance of submission fees is critical to its success. It is an observable fact that authors will accept them in some circumstances. Author acceptance would require further study though. Based on the interviews and the modelling in the study one model in particular is regarded as the most suitable way to meet the current requirements (i.e. to strengthen open access to research publications). In this model authors pay a submission fee plus an Article Processing Fee and the article is subsequently made available in open access. Both fees are set at levels that balance acceptability with the author community with securing a meaningful mix of revenues for the Publisher.

Of sets of offsets: Cumulative impacts and strategies for compensatory restoration

Biodiversity offsets are increasingly advocated as a flexible approach to managing the ecological costs of economic development. Arguably, however, this remains an area where policy-making has run ahead of science. A growing number of studies identify limitations of offsets in achieving ecologically sustainable outcomes, pointing to ethical and implementation issues that may undermine their effectiveness. We develop a novel system dynamic modelling framework to analyze the no net loss objective of development and biodiversity offsets. The modelling framework considers a marine-based example, where resource abundance depends on a habitat that is affected by a sequence of development projects, and biodiversity offsets are understood as habitat restoration actions. The model is used to explore the implications of four alternative offset management strategies for a regulator, which differ in how net loss is measured, and whether and how the cumulative impacts of development are considered. Our results confirm that, when it comes to offsets as a conservation tool, the devil lies in the details. Approaches to determining the magnitude of offsets required, as well as their timing and allocation among multiple developers, can result in potentially complex and undesired sets of economic incentives, with direct impacts on the ability to meet the overall objective of ecologically sustainable development. The approach and insights are of direct interest to conservation policy design in a broad range of marine and coastal contexts.

From the human rights-based approach to an ecological approach on how to achieve successful inclusion in international disability education

The barriers that people with disabilities face around the world are not only inherent to the limitations resulting from the disability itself, but, more importantly, these barriers rest with the societal technologies of exclusion. Using a mixed methodology approach, I conduct a quest to revealing several societal factors that limit full participation of people with disabilities in their communities, which will contribute to understanding and developing a more comprehensive framework for full inclusion of people with disabilities into the society. First, I conduct a multiple regression analysis to seek whether there is a statistical relationship between the national level of development, the level of democratization, and the level of education within a country’s population on one hand, and expressed concern for and preparedness to improve the quality of life for people of disabilities on another hand. The results from the quantitative methodology reveal that people without disabilities are more prepared to take care of people with disabilities when the level of development of the country is higher, when the people have more freedom of expression and hold the government accountable for its actions, and when the level of corruption is under control. However, a greater concern for the well-being of people with disabilities is correlated with a high level of country development, a decreased value of political stability and absence of violence, a decreased level of government effectiveness, and a greater level of law enforcement. None of the dependent variables are significantly correlated with the level of education from a given country. Then, I delve into an interpretive analysis to understand multiple factors that contribute to the construction of attitudes and practices towards people with disabilities. In doing this, I build upon the four main principles outlined by the United Nations as strongly recommended to be embedded in all international programmes: (1) identification of claims of human rights and the corresponding obligations of governments, hence, I assess and analyze disability rights in education, looking at United Nation, United States, and European Union Perspectives Educational Rights Provisions for People with Disabilities (Ch. 3); (2) estimated capacity of individuals to claim their rights and of governments to fulfill their obligations, hence, I look at the people with disabilities as rights-holders and duty-bearers and discuss the importance of investing in special capital in the context of global development (Ch. 4); (3) programmes monitor and evaluate the outcomes and the processes under the auspices of human rights standards, hence, I look at the importance of evaluating the UN World Programme of Action Concerning People with Disabilities from multiple perspectives, as an example of why and how to monitor and evaluate educational human rights outcomes and processes (Ch. 5); and (4) programming should reflect the recommendations of international human rights bodies and mechanisms, hence, I focus on programming that fosters development of the capacity of people with disabilities, that is, planning for an ecology of disabilities and ecoducation for people with disabilities (Ch. 6). Results from both methodologies converge to a certain point, and they further complement each other. One common result for the two methodologies employed is that disability is an evolving concept when viewed in a broader context, which integrates the four spaces that the ecological framework incorporates. Another common result is that factors such as economic, social, legal, political, and natural resources and contexts contribute to the health, education and employment opportunities, and to the overall well-being of people with disabilities. The ecological framework sees all these factors from a meta-systemic perspective, where bi-directional interactions are expected and desired, and also from a human rights point of view, where the inherent value of people is upheld at its highest standard.

HIV Disclosure: Parental dilemma in informing HIV infected Children about their HIV Status in Malawi

Background Increasingly many perinatally HIV-infected children are surviving through adolescence and adulthood as a result of improvements in the management of paediatric HIV infection, particularly the increased use of combination therapy. It is usually the parents or guardians of these children who are faced with the task of informing the child living with HIV about his or her positive status. However, many parents—particularly biological parents —find this disclosure process difficult to initiate, and this study explored some of the difficulties that these parents encounter. Objective This study set out to explore potential factors that challenge parents and guardians when informing their perinatally HIV-infected child about the child’s HIV status. Design This was a qualitative narrative study that employed in-depth interviews with parents or guardians of children perinatally infected with HIV. A total of 20 parents and guardians of children who attend the outpatient HIV clinic at the Baylor College of Medicine-Abbott Fund Children’s Clinical Centre of Excellence (COE) in Lilongwe, Malawi were interviewed. Of these, 14 were biological parents and six were guardians. Results Guardians and parents expressed uneasiness and apprehension with the disclosure conversation, whether or not they had already told their child that he or she had HIV. Participants who had not told their children recounted that they had contemplated starting the conversation but could not gather enough courage to follow through with those thoughts. They cited the fear of robbing their child of the happiness of living without the knowledge of being positive, fear of making their own status known to more people, and fear of confrontation or creating enmity with their child as impediments to disclosing their child’s positive HIV status to him or her. Conclusions It is apparent that guardians—more particularly biological parents—of children perinatally infected by HIV find it difficult to inform their children about their children’s HIV status. From this disempowered position, parents dread the disclosure of a positive HIV status to a child as a psychosocial process that has the potential to disturb a family’s previously established equilibrium with threats of stigmatization, marginalization, and parent-child conflict. This calls for strategies that could support parents to make disclosure to the child less challenging.

How can personal role engagement lead to increased engagement? The roles of meaningfulness and perceived line manager relations

There is an increasing need to understand the psychological processes that link personal development with employee engagement, particularly the boundary conditions at which these occur. The current study sought to meet this need by testing whether perceived opportunities for development are positively associated with job engagement indirectly through the experience of meaningfulness, and whether this indirect relationship is conditional on the level of perceived line manager relations. Questionnaire data was collected from 152 UK workers from a range of occupations and organizations. The results found support for all the hypotheses. In particular, the positive effects of perceived opportunities for development on job engagement (measured one month later) via meaningfulness were only significant for those who perceived that they had a good relationship with their line manager. Thus, there is a need for line managers to develop high quality relationships with their direct reports in order for development practices to translate into positive psychological outcomes. Engagement theory could be advanced by further understanding broaden-and-build and social exchange processes.

Cognitive and Visual Speech Contributions to Speech Perception in Challenging Listening Conditions

Speech perception routinely takes place in noisy or degraded listening environments, leading to ambiguity in the identity of the speech token. Here, I present one review paper and two experimental papers that highlight cognitive and visual speech contributions to the listening process, particularly in challenging listening environments. First, I survey the literature linking audiometric age-related hearing loss and cognitive decline and review the four proposed causal mechanisms underlying this link. I argue that future research in this area requires greater consideration of the functional overlap between hearing and cognition. I also present an alternative framework for understanding causal relationships between age-related declines in hearing and cognition, with emphasis on the interconnected nature of hearing and cognition and likely contributions from multiple causal mechanisms. I also provide a number of testable hypotheses to examine how impairments in one domain may affect the other. In my first experimental study, I examine the direct contribution of working memory (through a cognitive training manipulation) on speech in noise comprehension in older adults. My results challenge the efficacy of cognitive training more generally, and also provide support for the contribution of sentence context in reducing working memory load. My findings also challenge the ubiquitous use of the Reading Span test as a pure test of working memory. In a second experimental (fMRI) study, I examine the role of attention in audiovisual speech integration, particularly when the acoustic signal is degraded. I demonstrate that attentional processes support audiovisual speech integration in the middle and superior temporal gyri, as well as the fusiform gyrus. My results also suggest that the superior temporal sulcus is sensitive to intelligibility enhancement, regardless of how this benefit is obtained (i.e., whether it is obtained through visual speech information or speech clarity). In addition, I also demonstrate that both the cingulo-opercular network and motor speech areas are recruited in difficult listening conditions. Taken together, these findings augment our understanding of cognitive contributions to the listening process and demonstrate that memory, working memory, and executive control networks may flexibly be recruited in order to meet listening demands in challenging environments.

Les facteurs affectant les taux de réussite des cours d’anglais et de sciences humaines des étudiants dans les programmes de formation technique

A large percentage of Vanier College's technology students do not attain their College degrees within the scheduled three years of their program. A closer investigation of the problem revealed that in many of these cases these students had completed all of their program professional courses but they had not completed all of the required English and/or Humanities courses. Fortunately, most of these students do extend their stay at the college for the one or more semesters required for graduation, although some choose to go on into the workforce without returning to complete the missing English and/or Humanities and without their College Degrees. The purpose of this research was to discover if there was any significant measure of association between a student's family linguistic background, family cultural background, high school average, and/or College English Placement Test results and his or her likelihood of succeeding in his or her English and/or Humanities courses within the scheduled three years of the program. Because of both demographic differences between 'hard' and 'soft' technologies, including student population, more specifically gender ratios and student average ages in specific programs; and program differences, including program writing requirements and types of practical skill activities required; in order to have a more uniform sample, the research was limited to the hard technologies where students work hands-on with hardware and/or computers and tend to have overall low research and writing requirements. Based on a review of current literature and observations made in one of the hard technology programs at Vanier College, eight research questions were developed. These questions were designed to examine different aspects of success in the English and Humanities courses such as failure and completion rates and the number of courses remaining after the end of the fifth semester and as well examine how the students assessed their ability to communicate in English. The eight research questions were broken down into a total of 54 hypotheses. The high number of hypotheses was required to address a total of seven independent variables: primary home language, high school language of instruction, student's place of birth (Canada, Not-Canada), student's parents' place of birth (Both-born-in-Canada, Not-both-born-in-Canada), high school averages and English placement level (as a result of the College English Entry Test); and eleven dependent variables: number of English completed, number of English failed, whether all English were completed by the end of the 5th semester (yes, no), number of Humanities courses completed, number of Humanities courses failed, whether all the Humanities courses were completed by the end of the 5th semester (yes, no), the total number of English and Humanities courses left, and the students' assessments of their ability to speak, read and write in English. The data required to address the hypotheses were collected from two sources, from the students themselves and from the College. Fifth and sixth semester students from Building Engineering Systems, Computer and Digital Systems, Computer Science and Industrial Electronics Technology Programs were surveyed to collect personal information including family cultural and linguistic history and current language usages, high school language of instruction, perceived fluency in speaking, reading and writing in English and perceived difficulty in completing English and Humanities courses. The College was able to provide current academic information on each of the students, including copies of college program planners and transcripts, and high school transcripts for students who attended a high school in Quebec. Quantitative analyses were done on the data using the SPSS statistical analysis program. Of the fifty-four hypotheses analysed, in fourteen cases the results supported the research hypotheses, in the forty other cases the null hypotheses had to be accepted. One of the findings was that there was a strong significant association between a student's primary home language and place of birth and his or her perception of his or her ability to communicate in English (speak, read, and write) signifying that both students whose primary home language was not English and students who were not born in Canada, considered themselves, on average, to be weaker in these skills than did students whose primary home language was English. Although this finding was noteworthy, the two most significant findings were the association found between a student's English entry placement level and the number of English courses failed and the association between the parents' place of birth and the student's likelihood of succeeding in both his or her English and Humanities courses. According to the research results, the mean number of English courses failed, on average, by students placed in the lowest entry level of College English was significantly different from the number of English courses failed by students placed in any of the other entry level English courses. In this sample students who were placed in the lowest entry level of College English failed, on average, at least three times as many English courses as those placed in any of the other English entry level courses. These results are significant enough that they will be brought to the attention of the appropriate College administration. The results of this research also appeared to indicate that the most significant determining factor in a student's likelihood of completing his or her English and Humanities courses is his or her parents' place of birth (both-born-in-Canada or not-both-born-in-Canada). Students who had at least one parent who was not born in Canada, would, on average, fail a significantly higher number of English courses, be significantly more likely to still have at least one English course left to complete by the end of the 5th semester, fail a significantly higher number of Humanities courses, be significantly more likely to still have at least one Humanities course to complete by the end of the 5th semester and have significantly more combined English and Humanities courses to complete at the end of their 5th semester than students with both parents born in Canada. This strong association between students' parents' place of birth and their likelihood of succeeding in their English and Humanities courses within the three years of their program appears to indicate that acculturation may be a more significant factor than either language or high school averages, for which no significant association was found for any of the English and Humanities related dependent variables. Although the sample size for this research was only 60 students and more research needs to be conducted in this area, to see if these results are supported with other groups within the College, these results are still significant. If the College can identify, at admission, the students who will be more likely to have difficulty in completing their English and Humanities courses, the College will now have the opportunity to intercede during or before the first semester, and offer these students the support they require in order to increase their chances of success in their education, whether it be classes or courses designed to meet their specific needs, special mentoring, tutoring or other forms of support. With the necessary support, the identified students will have a greater opportunity of successfully completing their programs within the scheduled three years, while at the same time the College will have improved its capacity to meeting the needs of its students.

Estructuración de los procesos y la función de recursos humanos alineados con el direccionamiento estratégico en Kathmandu restaurante

El direccionamiento estratégico está destinado para que las organizaciones cumplan con sus metas y tengan perdurabilidad en el tiempo; es una forma metodológica en la cual se establecen La formulación y el planteamiento estratégicos, se identifican las brechas entre el sueño de la empresa y su realidad, para desplegar la plata forma estratégica. Kathmandu es un restaurante conocido por su diversidad cultural gastronómica, ubicado en Usaquén al Norte de Bogotá. Su serviespacio reúne los sabores, aromas, decoración y elixires del oriente, su música incluye una fusión de sonidos que permite materializar la experiencia que quiere brindar para satisfacer las expectativas de sus comensales y brindarles una experiencia diferente. Los fines de semana presentan shows de danza de vientre, para acompañar la comida y el rato que dispongan disfrutar en este lugar. Este restaurante tiene un diferenciador en su servicio, que le ofrece una ventaja competitiva, Kathmandu brinda la posibilidad de que además del deleite de sus platos, los clientes puedan adquirir toda la decoración de este lugar, estas son artesanías originales traídas de Nepal, India, Tailandia, Indonesia y sus alrededores. Otro atrayente de este restaurante son los cocteles alusivos a las regiones del oriente, y la narguile que ofrece a sus clientes. Al pasar de los años, ciertos inconvenientes presentados en el negocio, con los clientes, el personal y las utilidades, han hecho que los gerentes se preocupen por encontrar la raíz del problema y buscar la solución óptima para perdurar en el tiempo con los mejores beneficios posibles, pues las estrategias que estaban implementando no van acorde a su misión y visión, por lo que es necesario realizar una restructuración de ciertos procesos enfocados al direccionamiento estratégico. Se realizó un análisis en una reunión junto a las directivas sobre cada área de la organización donde se evidenciaron problemas que deben ser tratados para hacer de Kathmandu una empresa más eficiente, eficaz y productiva. Y prepararla para afrontar los cambios que el tiempo le presente, en cuanto a preferencias de los clientes, competencia, entre otras, bien sean a corto, mediano o largo plazo. Algunos de los principales problemas encontrados son: el servicio al cliente, la selección adecuada de personal y capacitación de este, la falta de manejo de un conducto jerárquico y repartición de funciones entre los colaboradores, el informe adecuado sobre la inconformidad de los clientes con su solución, el manual de funciones, el manejo de inventarios y su rotación, verificación de calidad de los productos, manejo de proveedores, entre otros. Kathmandu, a pesar de tener problemas evidentes, es una empresa que por los servicios y productos que ofrece sigue generando buenas utilidades, por esto los gerentes no le habían prestado la debida atención a estos inconvenientes que están poniendo en juego la perdurabilidad de la empresa y que afecta la optimización de las utilidades y minimización de costes sin afectar la calidad brindada al cliente. El objetivo de este restaurante es que el área de recursos humanos sea restructurada en cada uno de los procesos para articularla al direccionamiento estratégico de Kathmandu; pues en esta área se generan la mayoría de los problemas presentados anteriormente. El presente proyecto pretende diseñar el direccionamiento estratégico del área recursos humanos del restaurante Kathmandu para superar la problemática identificada y garantizar la efectividad de sus procesos y adicionalmente evidenciar la creencia de éxito sostenido que se manejaba en este lugar. Este proyecto se realizara con una metodología mixta, para tener aspectos de la investigación cuantitativa y cualitativa y poder realizar una investigación más completa que lleve a una óptima solución del problema abarcado. Se utilizara el direccionamiento estratégico como herramienta para replantear el área de recursos humanos de la organización y alcanzar la efectividad en sus procesos.

Vanadium Redox Flow Battery Storage System Linked to the Electric Grid

This paper focuses on technology state of the art for the charge/discharge of electric energy storage supported by vanadium redox flow battery linked to the electric grid. Properties of vanadium, the main configuration and the reaction of charge/discharge of a vanadium redox flow battery are addressed. The vanadium redox flow battery has the highest cell voltage among the other redox flow battery, implying higher power and energy density which favours application at power plants. This electric energy storage is viewed as a promising contribution to be integrated in power system due to a reasonably bulky size and to successful applications currently allowing storage of energy at power plants or at electrical grids. For instances, allowing storage of energy as an economic improvement providing spin reserve to avoid penalty for imbalances between the energy delivered and energy contracted at closing of electricity market or as an economic improvement to diminish the cost of electricity usage of a consumer. The vanadium redox flow battery has the advantages of scalability customized to meet requirements for power and energy capacity and of excellent combination of energy efficiency, capital cost and life cycle costs compared with other technology.

Hypertensive disorders of pregnancy and long-term cardiovascular health and outcomes

Introduction The maternal vasculature undergoes significant adaptations during pregnancy to meet the increased metabolic demands of the developing fetus. These adaptations include increased cardiac output and blood volume, as well as reduced systemic vascular resistance. In Hypertensive disorders of pregnancy (HDP) there is an impaired cardiovascular adaptation to pregnancy with effects extending beyond pregnancy. In the present study we aimed to characterize long-term cardiovascular status of women who suffered from HDP. Methods Fifty-eight women who attended at least one post-partum visit and a follow-up visit after at least 5 years from delivery were enrolled in the study. Exclusion criteria included multiple pregnancy, fetal genetic or congenital abnormalities, maternal history of organ transplantation, or chronic renal failure (eGFR≤45ml/min/1.73m2). In the follow-up visit participants underwent a complete cardiovascular assessment including echocardiography and multiparametric vascular function assessment. Results and Discussion Two major cardiovascular events, one stroke and one myocardial infarction, occurred both in women with index-pregnancy complicated by preeclampsia (PE). While not statistically significant, women with HDP-non-PE and PE displayed a trend towards an increased risk of developing composite cardiovascular outcome, and women with PE tended to experience it sooner. Nearly half of the women with a history of HDP, whether PE or HDP-non-PE, developed chronic hypertension. Some women also developed hyperuricemia, chronic kidney disease (CKD), and type 2 diabetes at follow- up, most of them had a previous history of PE. Structural and functional cardiac changes were observed in a few cases, especially among women with PE, and vascular dysfunction was more common in women with a history of HDP compared to those with normotensive pregnancies. Results of the present study adds on literature on long-term cardiovascular impact of HDP and further emphasize the importance of a timely follow-up of women who suffered from HDP and particularly PE.

Avaliação da consulta médica realizada por ingressantes na residência de Pediatria

Diversos autores relatam que a consulta médica se associa a melhores resultados quando se adota como referencial o modelo centrado no paciente. OBJETIVO: Avaliar se os médicos ingressantes na residência de Pediatria realizam consultas ambulatoriais segundo pressupostos do modelo centrado no paciente. MÉTODO: Em 2007, no início de seu estágio de ambulatório, dez residentes foram selecionados aleatoriamente para serem filmados durante a realização de uma consulta. Adotando-se como referencial teórico pressupostos do modelo centrado no paciente, os dados foram analisados por meio de metodologia qualitativa, por meio da técnica exploratória, com três juízes independentes. RESULTADOS: A maioria dos residentes explora precocemente a primeira queixa referida pelos pais, assumindo-a como principal; não explora outras queixas; decide e faz orientações terapêuticas de modo não compartilhado; conversa pouco com as crianças; cria longos momentos de silêncio durante a consulta; não explica o exame físico e às vezes utiliza o prontuário como a principal fonte de informação. CONCLUSÃO: Os residentes realizam consultas sem a inclusão da perspectiva dos pais e, portanto, não atendem segundo pressupostos do modelo centrado no paciente.

Differential regulation of PGC-1 alpha expression in rat liver and skeletal muscle in response to voluntary running

Background: The beneficial actions of exercise training on lipid, glucose and energy metabolism and insulin sensitivity appear to be in part mediated by PGC-1 alpha. Previous studies have shown that spontaneously exercised rats show at rest enhanced responsiveness to exogenous insulin, lower plasma insulin levels and increased skeletal muscle insulin sensitivity. This study was initiated to examine the functional interaction between exercise-induced modulation of skeletal muscle and liver PGC-1 alpha protein expression, whole body insulin sensitivity, and circulating FFA levels as a measure of whole body fatty acid (lipid) metabolism. Methods: Two groups of male Wistar rats (2 Mo of age, 188.82 +/- 2.77 g BW) were used in this study. One group consisted of control rats placed in standard laboratory cages. Exercising rats were housed individually in cages equipped with running wheels and allowed to run at their own pace for 5 weeks. At the end of exercise training, insulin sensitivity was evaluated by comparing steady-state plasma glucose (SSPG) concentrations at constant plasma insulin levels attained during the continuous infusion of glucose and insulin to each experimental group. Subsequently, soleus and plantaris muscle and liver samples were collected and quantified for PGC-1 alpha protein expression by Western blotting. Collected blood samples were analyzed for glucose, insulin and FFA concentrations. Results: Rats housed in the exercise wheel cages demonstrated almost linear increases in running activity with advancing time reaching to maximum value around 4 weeks. On an average, the rats ran a mean (Mean +/- SE) of 4.102 +/- 0.747 km/day and consumed significantly more food as compared to sedentary controls (P < 0.001) in order to meet their increased caloric requirement. Mean plasma insulin (P < 0.001) and FFA (P < 0.006) concentrations were lower in the exercise-trained rats as compared to sedentary controls. Mean steady state plasma insulin (SSPI) and glucose (SSPG) concentrations were not significantly different in sedentary control rats as compared to exercise-trained animals. Plantaris PGC-1 alpha protein expression increased significantly from a 1.11 +/- 0.12 in the sedentary rats to 1.74 +/- 0.09 in exercising rats (P < 0.001). However, exercise had no effect on PGC-1 alpha protein content in either soleus muscle or liver tissue. These results indicate that exercise training selectively up regulates the PGC-1 alpha protein expression in high-oxidative fast skeletal muscle type such as plantaris muscle. Conclusion: These data suggest that PGC-1 alpha most likely plays a restricted role in exercise-mediated improvements in insulin resistance (sensitivity) and lowering of circulating FFA levels.