Efeito da exposição ao tabagismo e da mobilidade social sobre o crescimento e ganho de peso do nascimento à adolescência em uma coorte de base populacional de Cuiabá-MT

Esta tese é composta por três artigos que permitiram avaliar o efeito da exposição ao tabagismo durante a gestação e no início da infância sobre o crescimento linear e ganho de peso do nascimento à adolescência, além de verificar o efeito do nível socioeconômico no início da infância e da mobilidade social sobre a adiposidade até a adolescência. Foram utilizados para este fim os dados de uma coorte de crianças nascidas entre 1994 e 1999 na cidade de Cuiabá-MT. Essas crianças fizeram parte de um estudo de base populacional realizado na cidade de Cuiabá, entre 1999 e 2000, com 2405 crianças (0 a 5 anos) e foram selecionadas aleatoriamente em unidades básicas de saúde quando da vacinação. As mães foram entrevistadas após a vacinação, quando foram obtidos dados relativos à exposição ao tabagismo gestacional, tabagismo passivo, nível socioeconômico das famílias e dados antropométricos. Entre 2009 e 2011, após aproximadamente 11 anos, essas crianças foram localizadas por meio do Censo Escolar e então 1716 adolescentes entre 10 e 17 anos de idade (71,4% da população) foram reavaliados nas escolas da rede pública e privada de Cuiabá, de 18 municípios do estado e outras 5 capitais do país. A análise por modelos lineares de efeitos mistos permitiu verificar a mudança de estatura e Índice de Massa Corporal (IMC) entre o nascimento e a adolescência. O primeiro e o segundo artigo desta tese avaliaram o efeito da exposição ao tabagismo materno durante a gestação e no início da infância sobre o crescimento linear e o IMC entre o nascimento e a adolescência. Crianças expostas ao tabagismo materno durante a gestação e no início da infância apresentaram menor estatura desde o nascimento até a adolescência quando comparadas às crianças não expostas. Quanto à adiposidade, entre o nascimento e a infância a mudança do IMC foi similar entre as crianças expostas e não expostas ao tabagismo materno, porém, entre a infância e a adolescência, aquelas expostas apenas durante a gestação mostraram maior ganho de IMC. Em conjunto, os dados corroboram o efeito deletério do tabagismo sobre o crescimento, efeito já bastante estudado, mas também indicam que avaliar e comparar exposição gestacional com pós-gestacional é importante, dado que seus efeitos parecem ser diferentes. O terceiro artigo avaliou o efeito do nível socioeconômico no início da infância e da mobilidade social entre a infância e a adolescência sobre o IMC do nascimento à adolescência. Para avaliar o nível socioeconômico, as famílias foram classificadas em nível econômico alto, médio e baixo, a partir do Critério de Classificação Econômica Brasil. Foi observada expressiva mobilidade social na população, principalmente entre os de menor nível econômico. Houve maior aumento do IMC entre o nascimento e a adolescência entre aqueles de maior nível econômico na infância e aqueles que permaneceram nas classes mais elevadas, indicando que a posição inicial foi o maior determinante das mudanças observadas no IMC.

Consumo alimentar e associação com ganho de peso em adolescente: Estudo Longitudinal de Avaliação Nutricional de Adolescentes (ELANA).

Essa tese teve como objetivo avaliar a associação do consumo de padrões alimentares e produtos alimentícios ultraprocessados (UP) sobre indicadores antropométricos e sua variação entre adolescentes. Para tal, foram analisados os dados de 1.031 estudantes de quatro escolas privadas e duas escolas públicas da região metropolitana do Rio de Janeiro que foram acompanhados por três anos consecutivos (2010 a 2012) no Estudo Longitudinal de Avaliação Nutricional de adolescentes (ELANA). Os resultados estão apresentados em três manuscritos que compõem a tese. O primeiro manuscrito identificou três padrões alimentares: Ocidental, composto por massas, embutidos e bacon, carnes, doces, bebidas açucaradas, salgados e fast food, biscoito, pães e cereais, leite e derivados e ovos, o Saudável, caracterizado por peixes, hortaliças, verduras, raízes e feculentos, frutas e sucos e o Arroz/Feijão, composto pelo consumo de arroz, feijão e café. Na análise dos dados na linha de base o padrão Ocidental associou-se a um menor índice de massa corporal (IMC) e não foi observada associação estatisticamente significativa em relação ao percentual de gordura corpórea (%GC) e o padrão em questão. Adicionalmente, foi verificada uma associação negativa entre o padrão Arroz/Feijão e ambos os indicadores antropométricos sugerindo que esse padrão de consumo tradicional possa ser protetor para a obesidade. No segundo manuscrito avaliou-se a relação entre o consumo de UP e indicadores de qualidade da dieta. O consumo de UP foi avaliado em gramas por dia e em gramas/total de calorias. Observou-se um aumento das variáveis marcadoras de alimentação não saudável e saudável com o aumento do consumo de UP. No entanto, quando relacionados ao aumento de consumo de UP/energia observou-se um aumento de marcadores de alimentação não saudável e, com exceção da vitamina C, uma redução de marcadores de alimentação saudável. Assim, a densidade do consumo de UP mostrou-se um bom indicador de qualidade da dieta entre adolescentes. No terceiro manuscrito avaliou-se a associação entre o consumo de UP e a evolução temporal do IMC e %GC. A análise longitudinal por modelos lineares mistos, que levam em conta todas as observações ao longo do tempo, indicou que nas análises não ajustados havia uma associação negativa entre consumo de UP e o IMC e %GC, porém nas análises de UP/energia e nas análises ajustadas por atividade física e uma variável de controle para a qualidade do relato não mais foram observadas associações com o consumo de UP e as medidas antropométricas de adiposidade. Pode-se concluir que não evidenciamos associação do consumo de UP com medidas antropométricas de obesidade uma vez que o consumo elevado de UP associado ao crescimento do %GC nas análises transversais, não se manteve nas análises longitudinais. A discrepância entre os achados dos estudos seccionais e os longitudinais pode decorrer de confundimento residual nos estudos seccionais. Conclui-se, que para redução do ganho excessivo de peso, orientações relativas exclusivamente a um padrão de alimentação saudável que incorpora a ideia de UP, devem ser acompanhadas de redução da quantidade de alimentos consumidos.

Consumo alimentar e associação com ganho de peso em adolescente: Estudo Longitudinal de Avaliação Nutricional de Adolescentes (ELANA).

Essa tese teve como objetivo avaliar a associação do consumo de padrões alimentares e produtos alimentícios ultraprocessados (UP) sobre indicadores antropométricos e sua variação entre adolescentes. Para tal, foram analisados os dados de 1.031 estudantes de quatro escolas privadas e duas escolas públicas da região metropolitana do Rio de Janeiro que foram acompanhados por três anos consecutivos (2010 a 2012) no Estudo Longitudinal de Avaliação Nutricional de adolescentes (ELANA). Os resultados estão apresentados em três manuscritos que compõem a tese. O primeiro manuscrito identificou três padrões alimentares: Ocidental, composto por massas, embutidos e bacon, carnes, doces, bebidas açucaradas, salgados e fast food, biscoito, pães e cereais, leite e derivados e ovos, o Saudável, caracterizado por peixes, hortaliças, verduras, raízes e feculentos, frutas e sucos e o Arroz/Feijão, composto pelo consumo de arroz, feijão e café. Na análise dos dados na linha de base o padrão Ocidental associou-se a um menor índice de massa corporal (IMC) e não foi observada associação estatisticamente significativa em relação ao percentual de gordura corpórea (%GC) e o padrão em questão. Adicionalmente, foi verificada uma associação negativa entre o padrão Arroz/Feijão e ambos os indicadores antropométricos sugerindo que esse padrão de consumo tradicional possa ser protetor para a obesidade. No segundo manuscrito avaliou-se a relação entre o consumo de UP e indicadores de qualidade da dieta. O consumo de UP foi avaliado em gramas por dia e em gramas/total de calorias. Observou-se um aumento das variáveis marcadoras de alimentação não saudável e saudável com o aumento do consumo de UP. No entanto, quando relacionados ao aumento de consumo de UP/energia observou-se um aumento de marcadores de alimentação não saudável e, com exceção da vitamina C, uma redução de marcadores de alimentação saudável. Assim, a densidade do consumo de UP mostrou-se um bom indicador de qualidade da dieta entre adolescentes. No terceiro manuscrito avaliou-se a associação entre o consumo de UP e a evolução temporal do IMC e %GC. A análise longitudinal por modelos lineares mistos, que levam em conta todas as observações ao longo do tempo, indicou que nas análises não ajustados havia uma associação negativa entre consumo de UP e o IMC e %GC, porém nas análises de UP/energia e nas análises ajustadas por atividade física e uma variável de controle para a qualidade do relato não mais foram observadas associações com o consumo de UP e as medidas antropométricas de adiposidade. Pode-se concluir que não evidenciamos associação do consumo de UP com medidas antropométricas de obesidade uma vez que o consumo elevado de UP associado ao crescimento do %GC nas análises transversais, não se manteve nas análises longitudinais. A discrepância entre os achados dos estudos seccionais e os longitudinais pode decorrer de confundimento residual nos estudos seccionais. Conclui-se, que para redução do ganho excessivo de peso, orientações relativas exclusivamente a um padrão de alimentação saudável que incorpora a ideia de UP, devem ser acompanhadas de redução da quantidade de alimentos consumidos.

Min-Max Moving Horizon Estimation for a Class of Hybrid Systems

In this paper, a strategy for min-max Moving Horizon Estimation (MHE) of a class of uncertain hybrid systems is proposed. The class of hybrid systems being considered are Piecewise Affine systems (PWA) with both continuous valued and logic components. Furthermore, we consider the case when there is a (possibly structured) norm bounded uncertainty in each subsystem. Sufficient conditions on the time horizon and the penalties on the state at the beginning of the estimation horizon to guarantee convergence of the MHE scheme will be provided. The MHE scheme will be implemented as a mixed integer semidefinite optimisation for which an efficient algorithm was recently introduced.

Design of a 7 T Superconducting Magnet for Lanzhou Penning Trap

A penning trap system called LPT (LANZHOU PENNING TRAP) is now being developed for precise mass measurements in IMP (Institute of Modern Physics). The most key component of LPT is a superconducting magnet. A Phi 156 mm warm bore and two cylinder good field regions with a distance of 220 mm are required for trapping ions and measurements. As the required homogeneity is better than 0.5 ppm, several complicated coaxial coils are used to produce such a magnetic field. The size and position of these coils are optimized by using a method combining linear program with multiobjective optimization. Superconducting shim coils and passive shim pieces are used to eliminate inevitable winding tolerances and environmental influence. The fringe field is decreased to 5 Gs at 2 m line from the center of the magnet by active shielding coils. The designs of the mechanical structure, the quench protection system are also introduced in this paper.

复杂单臂机器人集束型装备调度模型

针对一类存在并行和可重入腔的复杂单臂机器人集束型装备的调度问题,通过对加工腔、机器人、并行和可重入腔中的各个机器人活动进行分析,推导出对应的时序约束关系,建立了问题的混合整数规划模型,从而获得最优的机器人动作序列和最小周期.调度实例表明了模型的可行性和高效性。

Association of candidate genes with flowering time and water-soluble carbohydrate content in Lolium perenne (L.)

Sk?t, L., Humphreys, J., Humphreys, M. O., Thorogood, D., Gallagher, J. A., Sanderson, R., Armstead, I. P., Thomas, I. D. (2007). Association of candidate genes with flowering time and water-soluble carbohydrate content in Lolium perenne (L.). Genetics, 177 (1), 535-547. Sponsorship: BBSRC RAE2008

Biodiversity change in the Irish uplands - the effects of grazing management

As a prominent form of land use across much of upland Europe, extensive livestock grazing may hold the key to the sustainable management of these landscapes. Recent agricultural policy reform, however, has resulted in a decline in upland sheep numbers, prompting concern for the biodiversity value of these areas. This study quantifies the effects of varying levels of grazing management on plant, ground beetle and breeding bird diversity and assemblage in the uplands and lowlands of hill sheep farms in County Kerry, Ireland. Farms represent a continuum of light to heavy grazing, measured using a series of field indicators across several habitats, such as the internationally important blanket bog, home to the ground beetle, Carabus clatratus. Linear mixed effects modelling and non-metric multidimensional scaling are employed to disentangle the most influential management and environmental factors. Grazing state may be determined by the presence of Molinia caerulea or Nardus stricta, and variables such as % traditional ewes, % vegetation litter and % scrub prove valuable indicators of diversity. Measures of ecosystem functioning, e.g. plant biomass (nutrient cycling) and % vegetation cover (erosion rates) are influenced by plant diversity, which is influenced by grazing management. Levels of the ecosystem service, soil organic carbon, vary with ground beetle abundance and diversity, potentially influencing carbon sequestration and thereby climate change. The majority of species from all three taxa are found in the lowlands, with the exception of birds such as meadow pipit and skylark. The scale of measurement should be determined by the size and mobility of the species in question. The challenge is to manage these high nature value landscapes using agri-environment schemes which enhance biodiversity by maintaining structural heterogeneity across a range of scales, altitudes and habitats whilst integrating the decisions of people living and working in these marginal areas.

Cost savings from relaxation of operational constraints on a power system with high wind penetration

Wind energy is predominantly a nonsynchronous generation source. Large-scale integration of wind generation with existing electricity systems, therefore, presents challenges in maintaining system frequency stability and local voltage stability. Transmission system operators have implemented system operational constraints (SOCs) in order to maintain stability with high wind generation, but imposition of these constraints results in higher operating costs. A mixed integer programming tool was used to simulate generator dispatch in order to assess the impact of various SOCs on generation costs. Interleaved day-ahead scheduling and real-time dispatch models were developed to allow accurate representation of forced outages and wind forecast errors, and were applied to the proposed Irish power system of 2020 with a wind penetration of 32%. Savings of at least 7.8% in generation costs and reductions in wind curtailment of 50% were identified when the most influential SOCs were relaxed. The results also illustrate the need to relax local SOCs together with the system-wide nonsynchronous penetration limit SOC, as savings from increasing the nonsynchronous limit beyond 70% were restricted without relaxation of local SOCs. The methodology and results allow for quantification of the costs of SOCs, allowing the optimal upgrade path for generation and transmission infrastructure to be determined.

Study protocol: home-based telehealth stroke care: a randomized trial for veterans.

BACKGROUND: Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. METHODS: We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. DISCUSSION: For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when patients live in remote locations, as is the case for many veterans. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00384748.

The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295).

BACKGROUND: Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. OBJECTIVES: We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention. METHODS: The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models). DISCUSSION: The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.

Genome-wide association study of Lp-PLA(2) activity and mass in the Framingham Heart Study.

Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is an emerging risk factor and therapeutic target for cardiovascular disease. The activity and mass of this enzyme are heritable traits, but major genetic determinants have not been explored in a systematic, genome-wide fashion. We carried out a genome-wide association study of Lp-PLA(2) activity and mass in 6,668 Caucasian subjects from the population-based Framingham Heart Study. Clinical data and genotypes from the Affymetrix 550K SNP array were obtained from the open-access Framingham SHARe project. Each polymorphism that passed quality control was tested for associations with Lp-PLA(2) activity and mass using linear mixed models implemented in the R statistical package, accounting for familial correlations, and controlling for age, sex, smoking, lipid-lowering-medication use, and cohort. For Lp-PLA(2) activity, polymorphisms at four independent loci reached genome-wide significance, including the APOE/APOC1 region on chromosome 19 (p = 6 x 10(-24)); CELSR2/PSRC1 on chromosome 1 (p = 3 x 10(-15)); SCARB1 on chromosome 12 (p = 1x10(-8)) and ZNF259/BUD13 in the APOA5/APOA1 gene region on chromosome 11 (p = 4 x 10(-8)). All of these remained significant after accounting for associations with LDL cholesterol, HDL cholesterol, or triglycerides. For Lp-PLA(2) mass, 12 SNPs achieved genome-wide significance, all clustering in a region on chromosome 6p12.3 near the PLA2G7 gene. Our analyses demonstrate that genetic polymorphisms may contribute to inter-individual variation in Lp-PLA(2) activity and mass.

Bacteria localization and chorion thinning among preterm premature rupture of membranes.

OBJECTIVE: Bacterial colonization of the fetal membranes and its role in pathogenesis of membrane rupture is poorly understood. Prior retrospective work revealed chorion layer thinning in preterm premature rupture of membranes (PPROM) subjects. Our objective was to prospectively examine fetal membrane chorion thinning and to correlate to bacterial presence in PPROM, preterm, and term subjects. STUDY DESIGN: Paired membrane samples (membrane rupture and membrane distant) were prospectively collected from: PPROM = 14, preterm labor (PTL = 8), preterm no labor (PTNL = 8), term labor (TL = 10), and term no labor (TNL = 8), subjects. Sections were probed with cytokeratin to identify fetal trophoblast layer of the chorion using immunohistochemistry. Fluorescence in situ hybridization was performed using broad range 16 s ribosomal RNA probe. Images were evaluated, chorion and choriodecidua were measured, and bacterial fluorescence scored. Chorion thinning and bacterial presence were compared among and between groups using Student's t-test, linear mixed effect model, and Poisson regression model (SAS Cary, NC). RESULTS: In all groups, the fetal chorion cellular layer was thinner at rupture compared to distant site (147.2 vs. 253.7 µm, p<0.0001). Further, chorion thinning was greatest among PPROM subjects compared to all other groups combined, regardless of site sampled [PPROM(114.9) vs. PTL(246.0) vs. PTNL(200.8) vs. TL(217.9) vs. TNL(246.5)]. Bacteria counts were highest among PPROM subjects compared to all other groups regardless of site sampled or histologic infection [PPROM(31) vs. PTL(9) vs. PTNL(7) vs. TL(7) vs. TNL(6)]. Among all subjects at both sites, bacterial counts were inversely correlated with chorion thinning, even excluding histologic chorioamnionitis (p<0.0001 and p = 0.05). CONCLUSIONS: Fetal chorion was uniformly thinner at rupture site compared to distant sites. In PPROM fetal chorion, we demonstrated pronounced global thinning. Although cause or consequence is uncertain, bacterial presence is greatest and inversely correlated with chorion thinning among PPROM subjects.

Basking sharks and oceanographic fronts: quantifying associations in the north‐east Atlantic

Understanding the mechanisms linking oceanographic processes and marine vertebrate habitat use is critical to effective management of populations of conservation concern. The basking shark Cetorhinus maximus has been shown to associate with oceanographic fronts – physical interfaces at the transitions between water masses – to exploit foraging opportunities resulting from aggregation of zooplankton. However, the scale, significance and variability of these observed associations have not yet been established. Here, we quantify the influence of mesoscale (10s – 100s km) frontal activity on habitat use over timescales of weeks to months. We use animal-mounted archival tracking with composite front mapping via Earth Observation (EO) remote sensing to provide an oceanographic context to individual shark movements. We investigate levels of association with fronts occurring over two spatio-temporal scales, (i) broad-scale seasonally persistent frontal zones and (ii) contemporaneous mesoscale thermal and chl-a fronts. Using random walk simulations and logistic regression within an iterative generalised linear mixed modelling (GLMM) framework, we find that seasonal front frequency is a significant predictor of shark presence. Temporally-matched oceanographic metrics also indicate that sharks demonstrate a preference for productive regions, and associate with contemporaneous thermal and chl-a fronts more frequently than could be expected at random. Moreover, we highlight the importance of cross-frontal temperature change and persistence, which appear to interact to affect the degree of prey aggregation along thermal fronts. These insights have clear implications for understanding the preferred habitats of basking sharks in the context of anthropogenic threat management and marine spatial planning in the northeast Atlantic.

Basking sharks and oceanographic fronts: quantifying associations in the north-east Atlantic

Understanding the mechanisms linking oceanographic processes and marine vertebrate habitat use is critical to effective management of populations of conservation concern. The basking shark Cetorhinus maximus has been shown to associate with oceanographic fronts – physical interfaces at the transitions between water masses – to exploit foraging opportunities resulting from aggregation of zooplankton. However, the scale, significance and variability of these observed associations have not yet been established. Here, we quantify the influence of mesoscale (10s – 100s km) frontal activity on habitat use over timescales of weeks to months. We use animal-mounted archival tracking with composite front mapping via Earth Observation (EO) remote sensing to provide an oceanographic context to individual shark movements. We investigate levels of association with fronts occurring over two spatio-temporal scales, (i) broad-scale seasonally persistent frontal zones and (ii) contemporaneous mesoscale thermal and chl-a fronts. Using random walk simulations and logistic regression within an iterative generalised linear mixed modelling (GLMM) framework, we find that seasonal front frequency is a significant predictor of shark presence. Temporally-matched oceanographic metrics also indicate that sharks demonstrate a preference for productive regions, and associate with contemporaneous thermal and chl-a fronts more frequently than could be expected at random. Moreover, we highlight the importance of cross-frontal temperature change and persistence, which appear to interact to affect the degree of prey aggregation along thermal fronts. These insights have clear implications for understanding the preferred habitats of basking sharks in the context of anthropogenic threat management and marine spatial planning in the northeast Atlantic.