Pulmonary Embolism Mortality in Brazil from 1989 to 2010: Gender and Regional Disparities

Abstract Background: A significant variation in pulmonary embolism (PE) mortality trends have been documented around the world. We investigated the trends in mortality rate from PE in Brazil over a period of 21 years and its regional and gender differences. Methods: Using a nationwide database of death certificate information we searched for all cases with PE as the underlying cause of death between 1989 and 2010. Population data were obtained from the Brazilian Institute of Geography and Statistics (IBGE). We calculated age-, gender- and region-specific mortality rates for each year, using the 2000 Brazilian population for direct standardization. Results: Over 21 years the age-standardized mortality rate (ASMR) fell 31% from 3.04/100,000 to 2.09/100,000. In every year between 1989 and 2010, the ASMR was higher in women than in men, but both showed a significant declining trend, from 3.10/100,000 to 2.36/100,000 and from 2.94/100,000 to 1.80/100,000, respectively. Although all country regions showed a decline in their ASMR, the largest fall in death rates was concentrated in the highest income regions of the South and Southeast Brazil. The North and Northeast regions, the lowest income areas, showed a less marked fall in death rates and no distinct change in the PE mortality rate in women. Conclusions: Our study showed a reduction in the PE mortality rate over two decades in Brazil. However, significant variation in this trend was observed amongst the five country regions and between genders, pointing to possible disparities in health care access and quality in these groups.

Coronary MR angiography: comparison of quantitative and qualitative data from four techniques.

OBJECTIVE: The optimal coronary MR angiography sequence has yet to be determined. We sought to quantitatively and qualitatively compare four coronary MR angiography sequences. SUBJECTS AND METHODS. Free-breathing coronary MR angiography was performed in 12 patients using four imaging sequences (turbo field-echo, fast spin-echo, balanced fast field-echo, and spiral turbo field-echo). Quantitative comparisons, including signal-to-noise ratio, contrast-to-noise ratio, vessel diameter, and vessel sharpness, were performed using a semiautomated analysis tool. Accuracy for detection of hemodynamically significant disease (> 50%) was assessed in comparison with radiographic coronary angiography. RESULTS: Signal-to-noise and contrast-to-noise ratios were markedly increased using the spiral (25.7 +/- 5.7 and 15.2 +/- 3.9) and balanced fast field-echo (23.5 +/- 11.7 and 14.4 +/- 8.1) sequences compared with the turbo field-echo (12.5 +/- 2.7 and 8.3 +/- 2.6) sequence (p < 0.05). Vessel diameter was smaller with the spiral sequence (2.6 +/- 0.5 mm) than with the other techniques (turbo field-echo, 3.0 +/- 0.5 mm, p = 0.6; balanced fast field-echo, 3.1 +/- 0.5 mm, p < 0.01; fast spin-echo, 3.1 +/- 0.5 mm, p < 0.01). Vessel sharpness was highest with the balanced fast field-echo sequence (61.6% +/- 8.5% compared with turbo field-echo, 44.0% +/- 6.6%; spiral, 44.7% +/- 6.5%; fast spin-echo, 18.4% +/- 6.7%; p < 0.001). The overall accuracies of the sequences were similar (range, 74% for turbo field-echo, 79% for spiral). Scanning time for the fast spin-echo sequences was longest (10.5 +/- 0.6 min), and for the spiral acquisitions was shortest (5.2 +/- 0.3 min). CONCLUSION: Advantages in signal-to-noise and contrast-to-noise ratios, vessel sharpness, and the qualitative results appear to favor spiral and balanced fast field-echo coronary MR angiography sequences, although subjective accuracy for the detection of coronary artery disease was similar to that of other sequences.

Willingness and preferred methods to help quitting smoking in Switzerland

Purpose: to assess among current smokers in Switzerland the willingness to quit and the preferred methods to help quitting smoking. Methods: cross-sectional study including 1265 current smokers (607 women and 658 men). Difficulty quitting smoking and the preferred methods to help quitting smoking were assessed by questionnaire. Results: 89% of women and 84% of men reported being "very difficult" or "difficult" to quit smoking. Almost three quarters of smokers (73% of women and 70% of men) reported some willingness to quit smoking, but less than 25% of them wanted to do so within the next 30 days, and only 64% within the next 6 months. Willingness to quit was stronger among younger smokers while no differences were found for gender, physical activity or education al Javel. The preferred methods to help quitting smoking were personalized counselling by a doctor (51.4%), acupuncture (35.9%); nicotine replacement therapy (37.6%); hypnosis (28.8%); information flyers (24.9%); autogenic training (15.3%); bupropion (15.2%); personalized counselling by a non-doctor (14.7%) and group interventions (13.2%). Acupuncture and hypnosis were more favoured by women, and autogenic training by younger smokers. Still, a sizable fraction (between 19 and 51%) of smokers did not know some of the methods to help quitting smoking. Conclusion: although more than two thirds of Swiss smokers want to quit, only a small fraction wishes to do so in the short term. Setter information regarding the different methods to help quitting is also necessary.

Gender and the professional career of primary care physicians in Andalusia (Spain).

Background: Although the proportion of women in medicine is growing, female physicians continue to be disadvantaged in professional activities. The purpose of the study was to determine and compare the professional activities of female and male primary care physicians in Andalusia and to assess the effect of the health center on the performance of these activities. Methods: Descriptive, cross-sectional, and multicenter study. Setting: Spain. Participants: Population: urban health centers and their physicians. Sample: 88 health centers and 500 physicians. Independent variable: gender. Measurements: Control variables: age, postgraduate family medicine specialty (FMS), patient quota, patients/day, hours/day housework from Monday to Friday, idem weekend, people at home with special care, and family situation. Dependent variables: 24 professional activities in management, teaching, research, and the scientific community. Self-administered questionnaire. Descriptive, bivariate, and multilevel logistic regression analyses. Results: Response: 73.6%. Female physicians: 50.8%. Age: female physicians, 49.1 ± 4.3 yrs; male physicians, 51.3 ± 4.9 yrs (p < 0.001). Female physicians with FMS: 44.2%, male physicians with FMS: 33.3% (p < 0.001). Female physicians dedicated more hours to housework and more frequently lived alone versus male physicians. There were no differences in healthcare variables. Thirteen of the studied activities were less frequently performed by female physicians, indicating their lesser visibility in the production and diffusion of scientific knowledge. Performance of the majority of professional activities was independent of the health center in which the physician worked. Conclusions: There are gender inequities in the development of professional activities in urban health centers in Andalusia, even after controlling for family responsibilities, work load, and the effect of the health center, which was important in only a few of the activities under study.

Right coronary MR angiography at 7 T: a direct quantitative and qualitative comparison with 3 T in young healthy volunteers.

PURPOSE: To objectively compare quantitative parameters related to image quality attained at coronary magnetic resonance (MR) angiography of the right coronary artery (RCA) performed at 7 T and 3 T. MATERIALS AND METHODS: Institutional review board approval was obtained, and volunteers provided signed informed consent. Ten healthy adult volunteers (mean age ± standard deviation, 25 years ± 4; seven men, three women) underwent navigator-gated three-dimensional MR angiography of the RCA at 7 T and 3 T. For 7 T, a custom-built quadrature radiofrequency transmit-receive surface coil was used. At 3 T, a commercial body radiofrequency transmit coil and a cardiac coil array for signal reception were used. Segmented k-space gradient-echo imaging with spectrally selective adiabatic fat suppression was performed, and imaging parameters were similar at both field strengths. Contrast-to-noise ratio between blood and epicardial fat; signal-to-noise ratio of the blood pool; RCA vessel sharpness, diameter, and length; and navigator efficiency were quantified at both field strengths and compared by using a Mann-Whitney U test. RESULTS: The contrast-to-noise ratio between blood and epicardial fat was significantly improved at 7 T when compared with that at 3 T (87 ± 34 versus 52 ± 13; P = .01). Signal-to-noise ratio of the blood pool was increased at 7 T (109 ± 47 versus 67 ± 19; P = .02). Vessel sharpness obtained at 7 T was also higher (58% ± 9 versus 50% ± 5; P = .04). At the same time, RCA vessel diameter and length and navigator efficiency showed no significant field strength-dependent difference. CONCLUSION: In our quantitative and qualitative study comparing in vivo human imaging of the RCA at 7 T and 3 T in young healthy volunteers, parameters related to image quality attained at 7 T equal or surpass those from 3 T.

Gender and attachment representations in the preschool years: comparisons between five countries

Bowlby proposed that the individual's social experiences, as early as in infancy, contribute to the construction of Internal Working Models (IWMs) of attachment, which will later guide the individual's expectations and behaviors in close relationships all along his or her life. The qualitative, individual characteristics of these models reflect the specificity of the individual's early experiences with attachment figures. The attachment literature globally shows that the qualities of IWMs are neither gender specific nor cultural specific. Procedures to evaluate IWMs in adulthood have been well established, based on narrative accounts of childhood experiences. Narrative procedures at earlier ages (e.g., in the preschool years) have been proposed, such as Bretherton's Attachment Story Completion Task (ASCT), to evaluate attachment representations. More than 500 ASCT narratives of preschoolers, coming from five different countries, have been collected, in the perspective of examining possible interactions between gender and culture regarding attachment representations. A specific Q-Sort coding procedure (CCH) has been used to evaluate several dimensions of the narratives. Girls' narratives appeared as systematically more secure than those of same-age boys, whatever their culture. The magnitude of gender differences, however, varied between countries. Taylor's model of gender-specific responses to stress and Harwood's and Posada's hypothesis on inter-cultural differences regarding caregiving are evoked to understand the differences across gender and countries.

Gender and socioeconomic disparities in BMI trajectories in the Seychelles using birth cohorts generated from serial population-based surveys.

ABSTRACT: BACKGROUND: The relationship between body mass index (BMI) and socioeconomic status (SES) tends to change over time and across populations. In this study, we examined, separately in men and women, whether the association between BMI and SES changed over successive birth cohorts in the Seychelles (Indian Ocean, African region). METHODS: We used data from all participants in three surveys conducted in 1989, 1994 and 2004 in independent random samples of the population aged 25-64 years in the Seychelles (N= 3'403). We used linear regression to model mean BMI according to age, cohort, SES and smoking status, allowing for a quadratic term for age to account for a curvilinear relation between BMI and age and interactions between SES and age and between SES and cohorts to test whether the relation between SES and BMI changed across subsequent cohorts. All analyses were performed separately in men and women. RESULTS: BMI increased with age in all birth cohorts. BMI was lower in men of low SES than high SES but was higher in women of low SES than high SES. In all SES categories, BMI increased over successive cohorts (1.24 kg/m2 in men and 1.51 kg/m2 for a 10-year increase in birth cohorts, p <0.001). The difference in BMI between men or women of high vs. low SES did not change significantly across successive cohorts (the interaction between SES and year of birth of cohort was statistically not significant). Smoking was associated with lower BMI in men and women (respectively -1.55 kg/m2 and 2.46 kg/m2, p <0.001). CONCLUSIONS: Although large differences exist between men and women, social patterning of BMI did not change significantly over successive cohorts in this population of a middle-income country in the African region.

Nutritional behaviour and beliefs of ski-mountaineers: a semi-quantitative and qualitative study.

BACKGROUND: Endurance athletes are advised to optimize nutrition prior to races. Little is known about actual athletes' beliefs, knowledge and nutritional behaviour. We monitored nutritional behaviour of amateur ski-mountaineering athletes during 4 days prior to a major competition to compare it with official recommendations and with the athletes' beliefs. METHODS: Participants to the two routes of the 'Patrouille des Glaciers' were recruited (A, 26 km, ascent 1881 m, descent 2341 m, max altitude 3160 m; Z, 53 km, ascent 3994 m, descent 4090 m, max altitude 3650 m). Dietary intake diaries of 40 athletes (21 A, 19 Z) were analysed for energy, carbohydrate, fat, protein and liquid; ten were interviewed about their pre-race nutritional beliefs and behaviour. RESULTS: Despite belief that pre-race carbohydrate, energy and fluid intake should be increased, energy consumption was 2416 ± 696 (mean ± SD) kcal · day(-1), 83 ± 17 % of recommended intake, carbohydrate intake was only 46 ± 13 % of minimal recommended (10 g · kg(-1) · day(-1)) and fluid intake only 2.7 ± 1.0 l · day(-1). CONCLUSIONS: Our sample of endurance athletes did not comply with pre-race nutritional recommendations despite elementary knowledge and belief to be compliant. In these athletes a clear and reflective nutritional strategy was lacking. This suggests a potential for improving knowledge and compliance with recommendations. Alternatively, some recommendations may be unrealistic.

A study of combustion phenomena in circulating fluidized beds by developing and applying experimental and modelling methods for laboratory-scale reactors

The results shown in this thesis are based on selected publications of the 2000s decade. The work was carried out in several national and EC funded public research projects and in close cooperation with industrial partners. The main objective of the thesis was to study and quantify the most important phenomena of circulating fluidized bed combustors by developing and applying proper experimental and modelling methods using laboratory scale equipments. An understanding of the phenomena plays an essential role in the development of combustion and emission performance, and the availability and controls of CFB boilers. Experimental procedures to study fuel combustion behaviour under CFB conditions are presented in the thesis. Steady state and dynamic measurements under well controlled conditions were carried out to produce the data needed for the development of high efficiency, utility scale CFB technology. The importance of combustion control and furnace dynamics is emphasized when CFB boilers are scaled up with a once through steam cycle. Qualitative information on fuel combustion characteristics was obtained directly by comparing flue gas oxygen responses during the impulse change experiments with fuel feed. A one-dimensional, time dependent model was developed to analyse the measurement data Emission formation was studied combined with fuel combustion behaviour. Correlations were developed for NO, N2O, CO and char loading, as a function of temperature and oxygen concentration in the bed area. An online method to characterize char loading under CFB conditions was developed and validated with the pilot scale CFB tests. Finally, a new method to control air and fuel feeds in CFB combustion was introduced. The method is based on models and an analysis of the fluctuation of the flue gas oxygen concentration. The effect of high oxygen concentrations on fuel combustion behaviour was also studied to evaluate the potential of CFB boilers to apply oxygenfiring technology to CCS. In future studies, it will be necessary to go through the whole scale up chain from laboratory phenomena devices through pilot scale test rigs to large scale, commercial boilers in order to validate the applicability and scalability of the, results. This thesis shows the chain between the laboratory scale phenomena test rig (bench scale) and the CFB process test rig (pilot). CFB technology has been scaled up successfully from an industrial scale to a utility scale during the last decade. The work shown in the thesis, for its part, has supported the development by producing new detailed information on combustion under CFB conditions.

Spectral and symbolic analysis of the effect of gender and postural change on cardiac autonomic modulation in healthy elderly subjects

The objective of this study was to use linear and non-linear methods to investigate cardiac autonomic modulation in healthy elderly men and women in response to a postural change from the supine to the standing position. Fourteen men (66.1 ± 3.5 years) and 10 women (65.3 ± 3.3 years) were evaluated. Beat-to-beat heart rate was recorded in the supine and standing positions. Heart rate variability was studied by spectral analysis, including both low (LFnu-cardiac sympathetic modulation (CSM) indicator) and high (HFnu-cardiac vagal modulation (CVM) indicator) frequencies in normalized units as well as the low frequency/high frequency (LF/HF) ratio. Symbolic analysis was performed using the following indexes: 0V% (CSM indicator), 1V% (CSM and CVM indicators), 2LV% (predominantly CVM indicator) and 2ULV% (CVM indicator). Shannon entropy was also calculated. Men presented higher LFnu and LF/HF ratio and lower HFnu and 1V% symbolic index (57.56, 4.14, 40.53, 45.96, respectively) than women (24.60, 0.45, 72.47, 52.69, respectively) in the supine position. Shannon entropy was higher among men (3.53) than among women (3.33) in the standing position, and also increased according to postural change in men (3.25; 3.53). During postural change, the LFnu (24.60; 49.85) and LF/HF ratio (0.45; 1.72) increased, with a concomitant decrease in HFnu (72.47; 47.56) and 2LV% (14.10; 6.95) in women. Women presented increased CSM in response to postural change and had higher CVM and lower CSM than men in the supine position. In conclusion, women in the age range studied presented a more appropriate response to a postural change than men, suggesting that cardiac autonomic modulation may be better preserved in women than in men.

Sustainable sourcing in global supply network: assessment of geographic challenges and management methods Case: Stora Enso

The purpose of this work was to describe and compare sourcing practices and challenges in different geographies, to discuss possible options to advance sustainability of global sourcing, and to provide examples to answer why sourcing driven by sustainability principles is so challenging to implement. The focus was on comparison between Europe & Asia & South-America from the perspective of sustainability adoption. By analyzing sourcing practices of the case company it was possible to describe main differences and challenges of each continent, available sourcing options, supplier relationships and ways to foster positive chance. In this qualitative case study gathered theoretical material was compared to extensive sourcing practices of case company in a vast supplier network. Sourcing specialist were interviewed and information provided by them analyzed in order to see how different research results and theories are reflecting reality and to find answers to proposed research questions.

Gender and Genre in 21st Century Visions of Sherlock Holmes

Sherlock Holmes has been one of the most-adapted characters in literature since his first appearance in A Study in Scarlet in Beeton's Christmas Annual in 1887. Each new adaptation must offer innovations that bring freshness and contemporary appeal to time-worn stories and concepts or risk irrelevancy; analyzing these changes closely sheds light on shifts in societal constructs. Taking this as a starting point, this thesis examines Sherlock and Elementary from a perspective of feminism and queer theory via methods of discourse and genre analyses, with texts ranging from 1931 to the present as objects of comparison. The research illuminates constructions of masculinity as they have changed over time, particularly the movement from an orderly, stable, rational construction of hegemonic masculinity to one that is chaotic, often violent, and anti-heroic in at least some aspects while still being invested in the status quo.

Gender and Space in Tehran

Abstract: This dissertation generally concentrates on the relationships between “gender” and “space” in the present time of urban life in capital city of Tehran. “Gender” as a changing social construct, differentiated within societies and through time, studied this time by investigation on “gender attitude” or “gender identity” means attitudes towards “gender” issues regarding Tehran residences. “Space” as a concept integrated from physical and social constituents investigated through focus on “spatial attitude” means attitudes towards using “living spaces” including private space of “house”, semi private semi public space of neighborhood and finally public spaces of the city. “Activities and practices” in space concentrated instead of “physical” space; this perspective to “space” discussed as the most justified implication of “space” in this debate regarding current situations in city of Tehran. Under a systematic approach, the interactions and interconnections between “gender” and “space” as two constituent variables of social organization investigated by focus on the different associations presented between different “gender identities” and their different “spatial identities”; in fact, “spatial identity” manifests “gender identity” and in opposite direction, “spatial identity” influences to construction of “gender identity”. The hypotheses of case study in Tehran defined as followed: • “Gender identity” is reflected on “spatial identity”. Various “gender identities” in Tehran present different perspectives of “space” or they identify “space” by different values. • As “gender identity” internalizes patriarchal oppression, it internalizes associated “spatial” oppression too. • Within the same social class, different “gender identities” related to men and women, present interconnected qualities, compared with “gender identities” related to men or women of different social classes. This situation could be found in the “spatial” perspectives of different groups of men and women too. • Following the upper hypotheses, “spatial” oppression differs among social classes of Tehran living in different parts of this city. This research undertook a qualitative study in Tehran by interviewing with different parents of both young daughter and son regarding their attitudes towards gender issues from one side and activities and behaviors of their children in different spaces from the other side. Results of case study indicated the parallel changes of parents’ attitudes towards “gender” and “spatial” issues; it means strong connection between “gender” and “space”. It revealed association of “equal” spatial attitudes with “open, neutral” gender attitudes, and also the association of “biased, unequal” spatial identities with “conservative patriarchal” gender identities. It was cleared too that this variable concept – gender space - changes by “sex”; mothers comparing fathers presented more equitable notions towards “gender spatial” issues. It changes too by “social class” and “educational level”, that means “gender spatial” identity getting more open equitable among more educated people of middle and upper classes. “Breadwinning status in the family” also presents its effect on the changes of “gender spatial” identity so participant breadwinners in the family expressed relatively more equitable notions comparing householders and housekeepers. And finally, “gender spatial” identity changes through “place” in the city and regarding South – North line of the city. The illustration of changes of “gender spatial” identity from “open” to “conservative” among society indicated not only vertical variation across social classes, furthermore the horizontal changing among each social class. These results also confirmed hypotheses while made precision on the third one regarding variable of sex. More investigations pointed to some inclusive spatial attitudes throughout society penetrated to different groups of “gender identities”, to “opens” as to “conservatives”, also to groups between them, by two opposite features; first kind, conservative biased spatial practices in favor of patriarchal gender relations and the second, progressive neutral actions in favor of equal gender relations. While the major reason for the inclusive conservative practices was referred to the social insecurity for women, the second neutral ones associated to more formal & safer spaces of the city. In conclusion, while both trends are associated deeply with the important issues of “sex” & “body” in patriarchal thoughts, still strong, they are the consequences of the transitional period of social change in macro level, and the challenges involved regarding interactions between social orders, between old system of patriarchy, the traditional biased “gender spatial” relations and the new one of equal relations. The case study drew an inhomogeneous illustration regarding gender spatial aspects of life in Tehran, the opposite groups of “open” and “conservative”, and the large group of “semi open semi conservative” between them. In macro perspective it presents contradicted social groups according their general life styles; they are the manifestations of challenging trends towards tradition and modernity in Iranian society. This illustration while presents unstable social situations, necessitates probing solutions for social integration; exploring the directions could make heterogeneous social groups close in the way they think and the form they live in spaces. Democratic approaches like participatory development planning might be helpful for the city in its way to more solidarity and sustainability regarding its social spatial – gender as well – development, in macro levels of social spatial planning and in micro levels of physical planning, in private space of house and in public spaces of the city.

The Kineticist's Workbench: Combining Symbolic and Numerical Methods in the Simulation of Chemical Reaction Mechanisms

The Kineticist's Workbench is a program that simulates chemical reaction mechanisms by predicting, generating, and interpreting numerical data. Prior to simulation, it analyzes a given mechanism to predict that mechanism's behavior; it then simulates the mechanism numerically; and afterward, it interprets and summarizes the data it has generated. In performing these tasks, the Workbench uses a variety of techniques: graph- theoretic algorithms (for analyzing mechanisms), traditional numerical simulation methods, and algorithms that examine simulation results and reinterpret them in qualitative terms. The Workbench thus serves as a prototype for a new class of scientific computational tools---tools that provide symbiotic collaborations between qualitative and quantitative methods.

Quantitative and qualitative differences in morphological traits revealed between diploid Fragaria species

Background and Aims: The aims of this investigation were to highlight the qualitative and quantitative diversity apparent between nine diploid Fragaria species and produce interspecific populations segregating for a large number of morphological characters suitable for quantitative trait loci analysis. Methods: A qualitative comparison of eight described diploid Fragaria species was performed and measurements were taken of 23 morphological traits from 19 accessions including eight described species and one previously undescribed species. A principal components analysis was performed on 14 mathematically unrelated traits from these accessions, which partitioned the species accessions into distinct morphological groups. Interspecific crosses were performed with accessions of species that displayed significant quantitative divergence and, from these, populations that should segregate for a range of quantitative traits were raised. Key Results: Significant differences between species were observed for all 23 morphological traits quantified and three distinct groups of species accessions were observed after the principal components analysis. Interspecific crosses were performed between these groups, and F2 and backcross populations were raised that should segregate for a range of morphological characters. In addition, the study highlighted a number of distinctive morphological characters in many of the species studied. Conclusions: Diploid Fragaria species are morphologically diverse, yet remain highly interfertile, making the group an ideal model for the study of the genetic basis of phenotypic differences between species through map-based investigation using quantitative trait loci. The segregating interspecific populations raised will be ideal for such investigations and could also provide insights into the nature and extent of genome evolution within this group.