A randomised controlled trial comparing weight adjusted dose versus fixed dose prophylactic phenylephrine infusion on maintaining systolic blood pressure during caesarean section under spinal anaesthesia.

Background: Spinal anaesthesia is the standard of care for elective caesarean delivery. It has advantages over general anaesthesia. However the sympathetic blockade induced by spinal anaesthesia results in an 80 percent incidence of hypotension without prophylactic management. Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in the parturient. A prophylactic phenylephrine infusion combined with a fluid co-load is proven to be an effective and safe method of maintaining maternal hemodynamic stability. While most published studies have assessed the effectiveness of a prophylactic phenylephrine fixed dose infusion, few studies have assessed the effect of a prophylactic phenylephrine weight adjusted dose infusion on maintaining maternal hemodynamic stability following spinal anesthesia for a cesarean delivery. Objective: To compare the incidence of hypotension between women undergoing elective caesarean section under spinal anaesthesia, receiving prophylactic phenylephrine infusion at a fixed dose of 37.5 micrograms per minute versus a weight adjusted dose of 0.5 micrograms per kilogram per minute. Methods: One hundred and eight patients scheduled for non-urgent caesarean section under spinal anaesthesia were randomized into 2 groups; control group and intervention group using a computer generated table of numbers. Control group; Received prophylactic phenylephrine fixed dose infusion at 37.5 micrograms per minute. Intervention group; Received prophylactic phenylephrine weight adjusted dose infusion at 0.5 micrograms per kilogram per minute Results: The two groups had similar baseline characteristics in terms of ; Age, sex, weight and height. There was a 35.2% incidence of hypotension in the fixed dose group and an 18.6% incidence of hypotension in the weight adjusted dose group. This difference was found to be of borderline statistical significance p-value 0.05, and the difference in the incidence rates between the two groups was found to be statistically significant p= 0.03. The difference in the incidence of reactive hypertension and bradycardia between the two groups was not statistically significant: p-value of 0.19 for reactive hypertension and p-value of 0.42 for the incidence of bradycardia. There was also no statistically significant difference in the use of phenylephrine boluses, use of atropine, intravenous fluid used and the number of times the infusion was stopped. Conclusion: Among this population, the incidence of hypotension was significantly less in the weight adjusted dose group than in the fixed dose group. There was no difference in the number of physician interventions required to keep the blood pressure within 20% of baseline, and no difference in the proportion of reactive hypertension or bradycardia between the two groups. Administering prophylactic phenylephrine infusion at a weight adjusted dose of 0.5 micrograms per kilogram per minute results in a lower incidence of hypotension compared to its administration at a fixed dose of 37.5 micrograms per minute.

Vinculação no adolescente com perturbação estado-limite da personalidade – Estudo exploratório

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Generalists versus specialists: toward a typology of batterers in prison

In this study we apply the versatile/specialist offender debate to the research of intimate partner violence. We propose the existence of two types of imprisoned male batterers: the generalist and the specialist batterer. The individual, family, and community characteristics of these types of batterers are further explored in 110 imprisoned males in the Penitentiary of Villabona (Spain). As for the individual characteristics, results indicate that the generalist batterer present higher levels of psychopathology (specially antisocial and borderline personality), sexist attitudes, and substance dependence. Specialist batterers presented higher levels of conflict in their family of origin. Finally, generalist batterers reported coming from more socially disordered communities and showed lower levels of participation and integration in these communities than the specialist batterer. These results suggest that the classical distinctions among batterers based on psychopathology and context of violence (whether general or family only) might be of little utility when applied to imprisoned male batterers.

Intento de suicidio por intoxicación con organosfosforado bajo administración parenteral (síndrome compartimental): reporte de un caso

INTRODUCCIÓN: La ideación e intento de suicidio constituyen entidades emergentes para el profesional de la salud mental; la ingesta de organofosforados (OF) es una de las maneras más frecuentes de intoxicación debido a su disponibilidad y fácil accesibilidad en nuestro medio (Ecuador); es común que quienes recurren a estas sustancias con fines auto líticos lo hacen por vía oral. Encontrar que alguien utilice la vía parenteral con esta finalidad es poco frecuente y es escasa la literatura al respecto, motivo por el cual se considera de importancia la publicación del siguiente caso. OBJETIVO: Describir los aspectos psicopatológicos del paciente que presentó un intento de suicidio con uso de organofosforados administrados por vía parenteral. MÉTODO: revisión, presentación y análisis de caso clínico. RESULTADOS: El paciente de 32 años fue internado en el Hospital Homero Castanier Crespo de la ciudad de Azogues (Ecuador) tras la severidad de sus lesiones causadas por la administración parenteral de OF; la valoración del estado mental del paciente llevó al diagnóstico de intento de suicidio psicodisplásico con trastorno del estado de ánimo y trastorno límite de la personalidad; fue diagnosticado además de absceso en miembro superior derecho y síndrome compartimental en miembro superior izquierdo, por lo que fue necesaria la realización del drenaje y fasciotomía respectivamente. CONCLUSIÓN: Los envenenamientos por plaguicidas como OF son los métodos más utilizados, se conoce que la ingesta de los OF es común, más no la administración parenteral como en el presente caso, que implicó un tratamiento tanto del área física y de la esfera mental

Intervenção psicomotora em saúde mental em contexto sócio ocupacional : intervenção com adultos com perturbações da saúde mental no Fórum Sócio Ocupacional do Grupo de Ação Comunitária

O presente relatório apresenta e descreve o percurso efetuado nas atividades de estágio no âmbito do 2º ano do Mestrado em Reabilitação Psicomotora na Faculdade de Motricidade Humana – Universidade de Lisboa. O relatório de estágio que se apresenta envolve uma contextualização das perturbações observadas bem como a descrição da intervenção psicomotora efetuada no Fórum Sócio Ocupacional do Grupo de Ação Comunitária, no âmbito da Saúde Mental Comunitária. As atividades desenvolvidas visaram estimular as capacidades de planeamento, avaliação e intervenção psicomotoras por parte da aluna, no contexto de intervenção onde se inseria, visando também a coordenação do seu trabalho com outros profissionais e com a comunidade. Ao longo do estágio foram desenvolvidas sessões de Psicomotricidade em grupo e individuais, bem como outras atividades relacionadas com a psicomotricidade fora das sessões. Durante o estágio foram ainda realizados dois estudos de caso e elaboradas sessões tendo em vista avaliações inicial e final efetuadas. Conclui-se no final deste relatório que a intervenção em Psicomotricidade em saúde mental em contexto comunitário é pertinente tendo em conta os resultados da avaliação efetuada.

Prevalence of Mental Health Problems in Children and Its Associated Socio-Familial Factors in Urban Population of Semnan, Iran (2012)

Background: The World Health Organization (WHO) defines mental health as “a state of well-being in which every individual realizes own potential, can cope with the normal pressures of life, is able to work effectively, and can make a contribution to community”. Objectives: Mental Health Problems (MHP) is a great concern for all societies in terms of its burden and impact. This survey screened MHP and its impact in an Iranian urban population aged 6 - 12 years old, and explored its associated socio-familial factors. Patients and Methods: The survey was conducted in the elementary schools of Semnan, using random cluster sampling. Collection and analysis of data was performed using the parent version of the “Strengths and Difficulties Questionnaire (SDQ)” and survey commands of Stata-nine, taking into account cluster effect and population weights. Associations were assessed by fitting simple and multiple logistic regression models. P < 0.05 was considered significant. Results: With regard to the SDQ total score, 19.3% (95% CI: 8.6, 30.1) scored above the normal threshold (9.6% abnormal, 9.7% borderline). The frequency of problems ranged between 16.1% (peer problems) and 8.4% (emotional symptoms), and in all subscales boys were affected more than girls. The impact score was abnormal in 68.4% of all children, and was greater in girls than in boys. “A previously diagnosed mental health disorder” (OR = 11.11, 95% CI: 5.55, 25.00), “male gender” (OR = 1.43, 95% CI: 1.10, 1.87 and “less time spent with the child by father” (OR = 1.61, 95% CI: 1.20, 2.17) were significantly associated with an abnormal SDQ. Conclusions: The high rate of MHP in 6 - 12 year-old children and the lack of any significant correlation with their age, underpins the importance of early screening for MHP in schools, with particular focus on high risk groups.

Phyllodes tumor of the breast: a clinic-pathologic study of 77 cases in a Hispanic cohort

Introduction: Breast Phyllodes tumors are rare breast tumors present in less than 1% of new cases of breast cancer, usually occurring among middle-aged women (40-50 yrs). Objective: This study shows diagnostic experience, surgical management and follows up of patients with this disease during a period of ten years in a oncology referral center. Methods: Retrospectively, breast cancer registries at the institution were reviewed, identifying 77 patients with Phyllodes tumors between 2002 and 2012, who had been operated on at the Instituto de Cancerología – Clínica Las Américas, in Medellín (Colombia). Clinical and histopathological data belonging to these cases was captured and analyzed and descriptive statistics were used. Results: The follow up median was 22.5 months (IQR: 10.5-60.0), average age was 47.2 yrs (SD: 12.4), mean tumor size was 3.6 cm (SD: 4.6), 88.3% of the patients (68 cases) presented negative margins and none of them received adjuvant chemotherapy. Of the patients with Phyllodes tumors; 33.8% had benign, 31.2% had borderline and 35.0% had malignant tumor. Disease-free survival was 85.8% and overall survival was 94.5%. Discussion: Reported data in this article is in accordance with what has been reported in worldwide literature. In our cohort even the high mean size of the tumors, the risk of local relapse and metastatic disease is low than previously reported in literature. Trials with longer follow up and molecular trials in Phyllodes tumors are necessary to understand the behavior of these tumors in Hispanics population.

Vazio e o buraco negro na patologia limite – Um contributo da/para a técnica Rorschach

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Work, class and conflict: a comparative study of three Cork factories, incorporating oral testimony

This dissertation presents a comparative study of three factories in Cork Harbour area, Sunbeam Wolsey (1927-90), Irish Steel (1939-2001) and the Ford Marina Plant (1917-84). All three factories were significant industrial employers in both a domestic (Irish) and a local (Cork) context and are broadly representative of the Irish manufacturing industry that was developed under the policies of tariff protection introduced in the 1930s and gradually phased out between the late 1950s and the mid-1980s. Sunbeam Wolsey was a textile and clothing concern located on the north side of Cork City that possessed a borderline monopoly within its economic sector and was among the largest private employers of female labour in twentieth century Ireland. Irish Steel was the country’s only steel mill, located on Haulbowline island, a brief ferry-ride from the seaside town of Cobh, and was unusual in being one of the few manufacturing concerns operated as a nationalised industry under the auspices of the state. The Ford Marina plant predated the introduction of protectionism by more than a decade and began as the centre of the Ford empire’s tractor manufacturing business, before switching to the production of private motor vehicles for the Irish market in 1932. All three industries were closed or sold off when the state withdrew support, either in the form of tariff protection (Ford, Sunbeam) or direct funding (Irish Steel). While devoting much attention to the three firms, the central concern of this dissertation is not the companies themselves (though the economic history portion of the dissertation is substantial), but the workers they employed, examining the lives of these individuals both as members of the Irish working class, and, more specifically, as employees of the three factories under consideration. The project can be best described as a comparative factory study, comparing and contrasting the three workforces, focusing primarily on industrial relation and the experience of work. This dissertation utilises both documentary evidence and a significant quantity of oral testimony, breaking new ground by making the workplace the central focus of its investigation. The principal aims of the study are: 1. To document the lives of those who worked in these factories, capturing through oral testimony their subjective experiences of social class and factory life, as well as differences among narrators in terms of gender and status. In achieving this aim, the study will provide a broader social context for its detailed analysis of work and industrial relations in each firm. 2. To analyse the three workplaces and determine how and why each developed such distinct systems of industrial relations at the factory level, as well as to compare and contrast these systems. 3. To examine the nature of work in each factory and to determine how work and industrial relations in each firm developed over time, relating these changes both to internal and external factors. Additionally, the project will provide a comparative analysis of these changes.

En jämförelse av upplevd produktivitet samt arbetstillfredsställelse mellan aktivitetsaserade och traditionella kontor.

Purpose: The aim with this study is to compare perceived productivity and job satisfaction between activity based offices and traditional offices. The goal is to investigate, through a quantitative comparison, productivity and job satisfaction between the office types, and if generations perceive this differently. Method: The method used in this study is a quantitative method, in form of a questionnaire. The questionnaire used was taken from a study made by Sahlström and Severin (2015) at the Royal Institute of Technology in Stockholm. The same questionnaire was taken because it had already been quality assured and had good content for the survey. Four IT companies were included in the study. Two of them had activity based offices and two of them had traditional office type. Literature review has also been a method in order to get a deeper understanding of the subject. Findings: The results of the study show that there are differences between the two office types in perceived productivity and job satisfaction. The traditional office type showed the best results. However, this result can be discussed since the two traditional offices differed widely in their responses. The results also show that there are differences between the generations experiencing productivity and job satisfaction of the various offices. The elder generation, Baby boomers, shows better results on the traditional office type and the younger generation, Generation Y, shows better results on the activity based offices. Implications: One conclusion to be drawn from this is that employees at traditional offices are more satisfied with their working place and experience increased productivity than employees on activity based offices. However, these results may be due to other factors than how the office environment affects the employees. Therefore, these results will not be recommended. Another conclusion is that the Baby boomers are experiencing higher productivity and job satisfaction of traditional office and Generation Y experiences higher productivity and job satisfaction on activity based office. These results can be recommended. Limitations: The limitations of this study are to examine only IT companies in Sweden with a maximal amount of employees of 150 persons. The results are, apart from the scattered results in the first issue, generally valid and can be applied to other IT companies. To succeed fully applicable results, a survey with more companies involved had been better. Then, detections of anomaly would easier have been discovered and possible disregards of certain results could have been done. Keywords: Perceived productivity - Self-rated assessment of employees on their own productivity. Traditional offices - In this work traditional offices includes cell offices and shared rooms. Activity based offices - Office where employees have no fixed work place and there are often zones to support different types of working.

UTFORMNING AV GÅNG-, CYKEL- OCH MOPED-NÄT ANPASSAT FÖR ELCYKEL

Purpose: An increase in the number of pedelecs on Swedish roads is according to studies soon reality. This creates a need to adapt the bmp-grid (bike-, moped- and pedestrian-grid) to pedelecs for them to experience good security, accessibility and comfort while using it. The guidelines Swedish municipalities follow are VGU(Design of Roads and Streets) and the GCM-manual(Bike-, moped-, and pedestrian-manual) which currently do not take society’s future increase of pedelecs into account. VGU and the GCM-manual are tools that are commonly used during planning and design of roads and streets. The aim of the thesis is to use current advice and recommendations on how to adapt the bmp-grid to the pedelec and with this complete current guidelines for bmp-infrastructure. Method: The document-analysis is made on current federal documents that have an impact on bmp-design. Scetch-suggestions were then developed from the author’s personal improvement suggestions and from advice and recommendations gathered during the document-analysis and the theoretical framework. Findings: It was discovered that if the bmp-grid’s design allow bikes traveling up to 30km/h and has a good standard for bicycles according to VGU, then the infrastructure generally fulfil the needs of the pedelec. Altough there are still areas in VGU that needs complements. This need to be done on the design-guidelines so they can aid the adaption of the infrastructure to the pedelec during the planning- and design process. Necessary steps according to the result is to give clearer notifications on bmp-design, issue guidelines for choosing DTS, motivate minimal widths on roads, categories bikers and pedestrians into separate groups, give out more detailed descriptions of when separation of bikers and pedestrians should be done and also to specify different types of bike-users. When taking needs and claim of the pedelec into consideration the result shows that: adaption of the whole bmp-grid to the pedelec is not possible, to simplify priorities the bmp-grid needs to be divided into different sections, space should be taken from the car-traffic, solutions with mixed-traffic and bike-fields for pedelecs can be used in low-speed areas, larger opportunities to connect towns to increase commuting with bicycles appeared with the pedelec. Implications: After examining current guidelines regarding the design of the bmp-grid and gathering opinions on this from interviews the conclusion is that several areas in VGU needs completion. The following are recommendations on how to take the pedelec into consideration during the design-process:• Connect towns and urban-areas with bmp-grids to make use of pedelecs capacity.• Where there is not enough space for both cars and separated pedelec- and bike lanes the speed for car-traffic can be lowered to 30km/h. This creates opportunities with mixed-traffic or bike-lanes.• The width of existing roads and streets are often greater than what’s described in VGU. They can be made smaller to free space on roads for bicycle-infrastructure.• To prioritize which parts of the bmp-grid that needs design to allow pedelecs the bmp-grid can be divided into main- and local grid. The main grid should be design with consideration to the needs and claim of the pedelecs. Limitations: The limitation of the study lies in that none of the interviews where done with employees in any of the bigger municipalities in Sweden. This gives the study a general application in small- to middle-sized cities but not in bigger cities.Keywords: elcykel, ebike, pedelec, utformning, cykel, infrastruktur, infrastructure, society, planering, utformning, säkerhet, fordonstyp

Modern trafik – En studie kring cykelfrämjandet i Umeå kommun

Purpose: To determine the progress in Umeå concerning the furtherance of bicycle traffic in the city and to investigate the possibility of a similar progress in Jönköping. Method: Semi structured interviews with officials, politicians and enthusiasts in Umeå and Jönköping, document analysis of documents provided by the municipalities and observations of Umeå city center. Findings: Umeå’s mindset around a sustainable society have been identified and the vast difference between the two cities is the time that they’ve actively worked with the bike issue and how public officials prioritize while planning. Umeå’s large advantage in their decision making is that officials and politicians are working towards the same goal and are united in the bike issue. This makes decisions regarding bicycle promotion easier to make. Due to the difference in conditions between the cities, the writers states that Umeå’s way of planning their traffic not necessarily is the right way for Jönköping to plan theirs. Implications: In order to develop it’s bicycle network, Jönköping must dare to let go of their old way of thinking. Instead of thinking that car traffic is necessary in a city, they should have the courage to take difficult decisions that benefit bicycle promotion and thus develop a sustainable transport system. Limitations: The study does not address the economic aspects that are involved in the development of an attractive bicycle network. Also the environmental issues are only dealt with in a thorough level, as it’s necessary to fulfill the study’s objectives. The study’s purpose is considered to be achieved but the result could have been even more developed if more parties were interviewed. Keywords: Bicycle path, bicycle, sustainable transport planning, sustainable society, sustainability, Umeå, Jönköping 

Agustina Bessa-Luís et la "con-fusion des genres"

Résumé : Cette étude cherche à déconstruire l’idée selon laquelle, dans l’œuvre de l’auteure Agustina Bessa-Luís, une caractérisation forte des personnages féminins conduit nécessairement à un effacement et à une absence de figures masculines fortes, ceci afin de démontrer que, la zone d’ombre dans laquelle ces hommes s’inscrivent, est symptomatique de ce que l’auteure définit comme le « refus d’un destin » au masculin. En effet, en dépeignant des personnages masculins fuyants et « borderline », l’auteure révèle chez ses personnages de papier un trouble dans le genre, lié à une « désorientation » résolument queer.   Mots-clés : Subversion/déconstruction, identités de genre, l’un/l’autre, Dandysme, queer.

Índice del perfil del donante renal (KDPI) como factor pronóstico del trasplante

La enfermedad renal crónica ha aumentado a nivel mundial y nacional, mientras que el número de donantes viene en descenso, y los pacientes en lista de espera aumentan. Los donantes cadavéricos son una opción para estos pacientes, y han sido utilizados en últimos años para aumentar los órganos disponibles. La evaluación de la calidad de estos es importante para optimizar su uso. Estudio analítico tipo cohorte retrospectiva, cálculo de KDPI en donantes cadavéricos, seguimiento función renal creatinina sérica 1 mes, 3 meses, 6 meses y un año. Correlación supervivencia del injerto, función renal, KDPI y EPTS. Análisis de supervivencia y regresión logística con variables del donante, receptor y acto quirúrgico.

Traços desadaptativos da personalidade, sintomas depressivos e afectividade positiva e negativa: Uma amostra com estudantes universitários

Pretendemos estudar quais os traços desadaptativos de personalidade que se relacionam com os sintomas depressivos, a afectividade positiva e negativa, numa amostra de 187 estudantes universitários, entre os 18 e os 43 anos. Calculámos as correlações entre as escalas de padrões de personalidade e as escalas de padrões graves de personalidade do Inventário Multiaxial clínico de Millon II (MCMI-II) com os sintomas depressivos avaliados pela Escala de Depressão do Centro de Estudos Epidemiológicos e com a afectividade positiva e negativa avaliadas pela Escala de Afectividade Positiva e Afectividade Negativa. Realizámos uma análise da regressão múltipla utilizando as escalas de padrões de personalidade do MCMI-II como predictores e o resultado na CES-O, como variável dependente. Obtivemos uma correlação significativa entre os padrões de personalidade borderline, masoquista, esquizotípico, negativista e evitante e paranóide e os sintomas depressivos. A afectividade negativa apresenta-se também positivamente correlacionada com os padrões dependente e esquizóide. A afectividade positiva correlacionou-se significativa e positivamente com os padrões histriónico e narcisista e negativamente com os padrões esquizóide, esquizotípico, negativista, borderline, evitante e masoquista. Na análise de regressão, o padrão borderline prevê a presença de sintomas depressivos e os padrões sádico e dependente também, mas num sentido negativo. /ABSTRACT: We intendend to study wich personality traits relate to depressiva symptoms, and positive and negative affectivity, in a sample of 187 university students, between 18 and 43 years. We did the correlation between the personality patterns scales and the personality patterns of severe personality with the depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale and the positive and negative affectivity measured by the Positive Affect and Negative Affect Shedule. We did a multiple regression analysis using the personality patterns scale of Millon Clinical Multiaxial lnventory (MCMI-II) as predictors and the result of CES-D, as dependent variable. We obtained a significant correlation between the borderline, masochist, schizotypal, negativistic, avoidant and paranoid personality patterns and the depressive symptoms. Negative affectivity relates also positively with dependent and schizoid patterns. Positive affectivity correlated significant and positively with histrionic and narcissistic personality patterns and negatively with schizoid, schizotypal, negativistic, borderline, avoidant and masochist personality patterns. ln the regression analysis, the borderline pattern predicts the presence of depressive symptoms as well as the sadistic and dependent, but in the negative sense.