Outcome Analysis of Immediate and Delayed Conservative Breast Surgery Reconstruction With Mastopexy and Reduction Mammaplasty Techniques

Background: Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. Method: Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. Results: There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval - 1.01-7.00; P = 0.049). Conclusions: On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.

Iron Concentrations in Breast Milk and Selected Maternal Factors of Human Milk Bank Donors

The aim of this study was to evaluate the relationship between iron concentration in mature breast milk and characteristics of 136 donors of a Brazilian milk bank. Iron, vitamin A, zinc, and copper concentrations were assessed in human milk and maternal blood. Data were collected on maternal anthropometrics, obstetric, socioeconomic, demographic, and lifestyle factors. Iron, zinc, and copper in milk and zinc and copper in blood were detected by spectrophotometry. Vitamin A in milk and blood was determined by high-performance liquid chromatography. Hemoglobin was measured by electronic counting and serum iron and ferritin by colorimetry and chemoluminescence, respectively. Transferrin and ceruloplasmin were determined by nephelometry. According to multivariate linear regression analysis, iron in milk was positively associated with vitamin A in milk and with smoking but negatively associated with timing of breast milk donation (P < .001). These results indicate that iron concentration in milk of Brazilian donors may be influenced by nutritional factors and smoking. J Hum Lact. 26(2):175-179

Reproductive biology of six Brazilian Myrtaceae: is there a syndrome associated with buzz-pollination?

The floral phenology and reproductive biology of six sympatric arboreal Myrtaceae species were studied in the coastal plain forest (Ubatuba, Brazil, 44 degrees 48`W 23 degrees 22`S), from September 1999 to April 2002. Flowering started in the transition from the driest to the most humid season (Sep/Oct) and lasted until March. The sequence with which the species flowered each year was consistently the same. However, the timing of flowering onset, peak, end, and overlap differed from one year to another. Myrtaceae species were classified as xenogamic according to the pollen:ovule ratios, but two of them seem to present some degree of self-compatibility. Flowers of all species opened at sunrise and lasted for I day. Bombus morio (Apidae: Bombini) was the most common visitor followed by Melipona rufiventris (Apidae: Meliponini). Buzz pollination in Myrtaceae was common at the study area and seems to be related to bees` behaviour and to some aspects of flowers` morphology.

Cladistic analysis of continuous modularized traits provides phylogenetic signals in Homo evolution

Evolutionary novelties in the skeleton are usually expressed as changes in the timing of growth of features intrinsically integrated at different hierarchical levels of development(1). As a consequence, most of the shape- traits observed across species do vary quantitatively rather than qualitatively(2), in a multivariate space(3) and in a modularized way(4,5). Because most phylogenetic analyses normally use discrete, hypothetically independent characters(6), previous attempts have disregarded the phylogenetic signals potentially enclosed in the shape of morphological structures. When analysing low taxonomic levels, where most variation is quantitative in nature, solving basic requirements like the choice of characters and the capacity of using continuous, integrated traits is of crucial importance in recovering wider phylogenetic information. This is particularly relevant when analysing extinct lineages, where available data are limited to fossilized structures. Here we show that when continuous, multivariant and modularized characters are treated as such, cladistic analysis successfully solves relationships among main Homo taxa. Our attempt is based on a combination of cladistics, evolutionary- development- derived selection of characters, and geometric morphometrics methods. In contrast with previous cladistic analyses of hominid phylogeny, our method accounts for the quantitative nature of the traits, and respects their morphological integration patterns. Because complex phenotypes are observable across different taxonomic groups and are potentially informative about phylogenetic relationships, future analyses should point strongly to the incorporation of these types of trait.

Sleep deprivation of rats: The hyperphagic response is real

Study Objectives: Chronic sleep deprivation of rats causes hyperphagia without body weight gain. Sleep deprivation hyperphagia is prompted by changes in pathways governing food intake; hyperphagia may be adaptive to sleep deprivation hypermetabolism. A recent paper suggested that sleep deprivation might inhibit ability of rats to increase food intake and that hyperphagia may be an artifact of uncorrected chow spillage. To resolve this, a palatable liquid diet (Ensure) was used where spillage is insignificant. Design: Sleep deprivation of male Sprague Dawley rats was enforced for 10 days by the flowerpot/platform paradigm. Daily food intake and body weight were measured. On day 10, rats were transcardially perfused for analysis of hypothalamic mRNA expression of the orexigen, neuropeptide Y (NPY). Setting: Morgan State University, sleep deprivation and transcardial perfusion; University of Maryland, NPY in situ hybridization and analysis. Measurements and Results: Using a liquid diet for accurate daily measurements, there was no change in food intake in the first 5 days of sleep deprivation. Importantly, from days 6-10 it increased significantly, peaking at 29% above baseline. Control rats steadily gained weight but sleep-deprived rats did not. Hypothalamic NPY mRNA levels were positively correlated to stimulation of food intake and negatively correlated with changes in body weight. Conclusion: Sleep deprivation hyperphagia may not be apparent over the short term (i.e., <= 5 days), but when extended beyond 6 days, it is readily observed. The timing of changes in body weight and food intake suggests that the negative energy balance induced by sleep deprivation prompts the neural changes that evoke hyperphagia.

Constraining the age of the iporanga formation with SHRIMP U-Pb zircon: Implications for possible ediacaran glaciation in the Ribeira Belt, SE Brazil

The Ribeira belt in SE Brazil is a Neoproterozoic to Early Palaeozoic orogen, whose architecture and history is not yet fully understood. The depositional age of many of the sedimentary sequences in the Ribeira Belt remains unconstrained, and with debate concerning their depositional environment and tectonic setting. In this paper we present SHRIMP zircon U/Pb age constraints for one such problematic unit in the Ribeira Belt the lporanga Formation - and discuss the significance of this age with regards to the timing of Neoproterozoic glacial events in southeast Brazil. Using a felsic volcanic unit immediately under the lporanga Formation and granite cobbles from breccias in its basal parts a reconnaissance SHRIMP U/Pb zircon maximum depositional age of 580 Ma is assigned for the base of this unit. This age is marginally younger than the 625605 Ma ages for intrusions into the Lajeado and Ribeira subgroups, with which the lporanga Formation is in tectonic contact. This indicates that the Lajeado and Ribeira subgroups are not stratigraphically equivalent to the lporanga Formation, as thought previously by some workers. The maximum depositional age of 580 Ma also places a maximum time constraint on the tectonic juxtaposition of the lporanga Formation with other supracrustal units, and on the greenschist facies metamorphism and isoclinal folding that affected it. The potential glacial origin for the lporanga Formation, if correct, would place it in the late Ediacaran - provisionally equivalent to the Gaskiers glaciation. (c) 2007 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

Closing the Clymene ocean and bending a Brasiliano belt: Evidence for the Cambrian formation of Gondwana, southeast Amazon craton

We report new paleomagnetic and geochronological data from Ediacaran rift-drift carbonates in the Paraguai belt at the southern end of the suture zone between the Amazon craton and the Sao Francisco and Rio de Plata cratons, South America. Early thrusting resulted in remagnetization ca. 528 +/- 36 Ma or later; the mean age is established by (40)Ar/(39)Ar encapsulation dating of mixed authigenic and detrital illite from remagnetized carbonates from the unmetamorphosed fold-thrust belt. This remagnetization overlaps with a 525 Ma Gondwana reference pole. Metamorphic illite from the slate belt yields (40)Ar/(39)Ar ages of 496-484 Ma, the timing of peak regional metamorphism. Oroclinal bending of the Paraguai belt was caused by a 90 degrees clockwise rotation of the east-west limb after ca. 528 Ma, probably reflecting the irregular margin of the southeast Amazon craton. The age of the Paraguai belt overlaps with that of the Pampean orogeny farther south along the western margin of the Rio de Plata craton, suggesting a coeval closure for the Clymene ocean separating the Amazon craton from the Sao Francisco and Rio de Plata cratons.

Implementation of Video Monitoring In Aluminium Industry

The aim was to evaluate results and experiences from development of new technology, a training program and implementation of strategies for the use of a video exposure monitoring method, PIMEX. Starting point of this study is an increased incidence of asthma among workers in the aluminium industry. Exposure peaks of fumes are supposed to play an important role. PIMEX makes it possible to link used work practice, use of control technology, and so forth to peaks. Nine companies participated in the project, which was divided into three parts, development of PIMEX technology, production of training material, and training in use of equipment and related strategies. The use of the video exposure monitoring method PIMEX offers prerequisites supporting workers participation in safety activities. The experiences from the project reveal the importance of good timing of primary training, technology development, technical support, and follow up training. In spite of a delay of delivery of the new technology, representatives from the participating companies declared that the experiences showed that PIMEX gave an important contribution for effective control of hazards in the companies. Eight out of nine smelters used the PIMEX method as a part of a strategy for control of workers exposure to fumes in potrooms. Possibilities to conduct effective control measures were identified. This article describes experiences from implementation of a, for this branch, new method supporting workers participation for workplace improvements.

Soft money : private foundations of party politics

In the area of campaign financing in federal elections, one of the most controversial issues is that of soft money. Soft money refers to those funds raised by the national party organizations for use on various grassroots and party-building activities. but which are not subject to the restraints of federal campaign finance law. Critics contend that these party-building activitie, such as generic television advertising, voter registration and get-out-the vote drives, provide ancillary benefits to federal candidates and should, therefore, be subject to federal contribution and expenditure limits. Critics further argue that because these funds are not subject to federal law and do benefit federal candidates, the national parties raise monies in amounts and from sources, such as corporations and unions, that are prohibited under federal law. Efforts to gain a better understanding of soft money have been hampered by a lack of data, as the national parties were not required to disclose their soft money receipts and transactions until 1991. The purpose of this study is to analyze data recently made available in an attempt to add the import of empirical evidence to the debate over soft money. The nature, size and timing of soft money contributions are investigated and national party soft money disbursements are examined. The findings suggest that any attempts to reform the soft money system must first consider its compensatory benefits. Most prominently, this includes the extent to which soft money has promoted the resurgence of the national party organizations in the context of election politics.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

The effect of options on coordination

This paper studies how constraints on the timing of actions affect equilibrium in intertemporal coordination problems. The model exhibits a unique symmetric equilibrium in cut-o¤ strategies. The risk-dominant action of the underlying one-shot game is selected when the option to delay effort is commensurate with the option to wait longer for others' actions. The possibility of waiting longer for the actions of others enhances coordination, but the option of delaying one s actions can induce severe coordination failures: if agents are very patient, they might get arbitrarily low expected payoffs even in cases where coordination would yield arbitrarily large returns.

Growing research where economies grow: essays on strategy and international expansion of companies from emerging countries

In recent years, emerging countries have assumed an increasingly prominent position in the world economy, as growth has picked up in these countries and slowed in developed economies. Two related phenomena, among others, can be associated with this growth: emerging countries were less affected by the 2008-2009 global economic recession; and they increased their participation in foreign direct investment, both inflows and outflows. This doctoral dissertation contributes to research on firms from emerging countries through four independent papers. The first group of two papers examines firm strategy in recessionary moments and uses Brazil, one of the largest emerging countries, as setting for the investigation. Data were collected through a survey on Brazilian firms referring to the 2008-2009 global recession, and 17 hypotheses were tested using structural equation modeling based on partial least squares. Paper 1 offered an integrative model linking RBV to literatures on entrepreneurship, improvisation, and flexibility to indicate the characteristics and capabilities that allow a firm to have superior performance in recessions. We found that firms that pre-recession have a propensity to recognize opportunities and improvisation capabilities for fast and creative actions have superior performance in recessions. We also found that entrepreneurial orientation and flexibility have indirect effects. Paper 2 built on business cycle literature to study which strategies - pro-cyclical or counter-cyclical – enable superior performance in recessions. We found that while most firms pro-cyclically reduce costs and investments during recessions, a counter-cyclical strategy of investing in opportunities created by changes in the environment enables superior performance. Most successful are firms with a propensity to recognize opportunities, entrepreneurial orientation to invest, and flexibility to efficiently implement these investments. The second group of two papers investigated international expansion of multinational enterprises, particularly the use of distance for their location decisions. Paper 3 proposed a conceptual framework to examine circumstances under which distance is less important for international location decisions, taking the new perspective of economic institutional distance as theoretical foundation. The framework indicated that the general preference for low-distance countries is lower: (1) when the company is state owned, rather than private owned; (2) when its internationalization motives are asset, resource, or efficiency seeking, as opposed to market seeking; and (3) when internationalization occurred after globalization and the advent of new technologies. Paper 4 compared five concurrent perspectives of distance and indicated their suitability to the study of various issues based on industry, ownership, and type, motive, and timing of internationalization. The paper also proposed that distance represents the disadvantages of host countries for international location decisions; as such, it should be used in conjunction with factors that represent host country attractiveness, or advantages as international locations. In conjunction, papers 3 and 4 provided additional, alternative explanations for the mixed empirical results of current research on distance. Moreover, the studies shed light into the discussion of differences between multinational enterprises from emerging countries versus those from advanced countries.

The role of consumer's risk aversion on price rigidity

This paper aims at contributing to the research agenda on the sources of price stickiness, showing that the adoption of nominal price rigidity may be an optimal firms' reaction to the consumers' behavior, even if firms have no adjustment costs. With regular broadly accepted assumptions on economic agents behavior, we show that firms' competition can lead to the adoption of sticky prices as an (sub-game perfect) equilibrium strategy. We introduce the concept of a consumption centers model economy in which there are several complete markets. Moreover, we weaken some traditional assumptions used in standard monetary policy models, by assuming that households have imperfect information about the ineflicient time-varying cost shocks faced by the firms, e.g. the ones regarding to inefficient equilibrium output leveIs under fiexible prices. Moreover, the timing of events are assumed in such a way that, at every period, consumers have access to the actual prices prevailing in the market only after choosing a particular consumption center. Since such choices under uncertainty may decrease the expected utilities of risk averse consumers, competitive firms adopt some degree of price stickiness in order to minimize the price uncertainty and fi attract more customers fi.'

Rent dissipation, political viability and the strategic adoption of free trade agreements

This paper studies the political viability of free trade agreements (FTAs). The key element of the analysis is the “rent dissipation” that these arrangements induce: by eliminating intra-bloc trade barriers, an FTA reduces the incentives of the local firms to lobby for higher external tariffs, thereby causing a reduction of the rents created in the lobbying process. The prospect of rent dissipation moderates the governments’ willingness to participate in FTAs; they will support only arrangements that are “substantially” welfare improving, and no FTA that reduces welfare. Rent dissipation also implies that the prospects of political turnover may create strategic reasons for the formation of FTAs. Specifically, a government facing a high enough probability of losing power may want to form a trade bloc simply to “tie the hands” of its successor. An FTA can affect the likelihood of political turnover as well. If the incumbent party has a known bias toward special interests, it may want to commit to less distortionary policies in order to reduce its electoral disadvantage; the rent dissipation effect ensures that an FTA can serve as the vehicle for such a commitment. In nascent/unstable democracies, the incumbent government can use a free trade agreement also to reduce the likelihood of a dictatorial takeover and to “consolidate” democracy – a finding that is consistent with the timing of numerous accessions to and formations of preferential arrangements.

Assessing the performance of private equity investments

This study presents an alternative investment projection model to estimate the future values of Private Equity (PE) investments. The performance of PE investments is assessed by analyzing the risk-return relationship relative to simulated Public Market (PM) investments that mimic the cash flow patterns of PE investments. The model allows for a quantified analysis of the underlying inputs that outline the PE performance and risks, and accounts for survivorship bias. These inputs include the fund manager’s decisions regarding the selection, leverage, size, duration and timing of investment and divestments.