Estimated Disability-adjusted Life Years Averted By Long-term Provision Of Long Acting Contraceptive Methods In A Brazilian Clinic.

What is the contribution of the provision, at no cost for users, of long acting reversible contraceptive methods (LARC; copper intrauterine device [IUD], the levonorgestrel-releasing intrauterine system [LNG-IUS], contraceptive implants and depot-medroxyprogesterone [DMPA] injection) towards the disability-adjusted life years (DALY) averted through a Brazilian university-based clinic established over 30 years ago. Over the last 10 years of evaluation, provision of LARC methods and DMPA by the clinic are estimated to have contributed to DALY averted by between 37 and 60 maternal deaths, 315-424 child mortalities, 634-853 combined maternal morbidity and mortality and child mortality, and 1056-1412 unsafe abortions averted. LARC methods are associated with a high contraceptive effectiveness when compared with contraceptive methods which need frequent attention; perhaps because LARC methods are independent of individual or couple compliance. However, in general previous studies have evaluated contraceptive methods during clinical studies over a short period of time, or not more than 10 years. Furthermore, information regarding the estimation of the DALY averted is scarce. We reviewed 50 004 medical charts from women who consulted for the first time looking for a contraceptive method over the period from 2 January 1980 through 31 December 2012. Women who consulted at the Department of Obstetrics and Gynaecology, University of Campinas, Brazil were new users and users switching contraceptive, including the copper IUD (n = 13 826), the LNG-IUS (n = 1525), implants (n = 277) and DMPA (n = 9387). Estimation of the DALY averted included maternal morbidity and mortality, child mortality and unsafe abortions averted. We obtained 29 416 contraceptive segments of use including 25 009 contraceptive segments of use from 20 821 new users or switchers to any LARC method or DMPA with at least 1 year of follow-up. The mean (± SD) age of the women at first consultation ranged from 25.3 ± 5.7 (range 12-47) years in the 1980s, to 31.9 ± 7.4 (range 16-50) years in 2010-2011. The most common contraceptive chosen at the first consultation was copper IUD (48.3, 74.5 and 64.7% in the 1980s, 1990s and 2000s, respectively). For an evaluation over 20 years, the cumulative pregnancy rates (SEM) were 0.4 (0.2), 2.8 (2.1), 4.0 (0.4) and 1.3 (0.4) for the LNG-IUS, the implants, copper IUD and DMPA, respectively and cumulative continuation rates (SEM) were 15.1 (3.7), 3.9 (1.4), 14.1 (0.6) and 7.3 (1.7) for the LNG-IUS, implants, copper IUD and DMPA, respectively (P < 0.001). Over the last 10 years of evaluation, the estimation of the contribution of the clinic through the provision of LARC methods and DMPA to DALY averted was 37-60 maternal deaths; between 315 and 424 child mortalities; combined maternal morbidity and mortality and child mortality of between 634 and 853, and 1056-1412 unsafe abortions averted. The main limitations are the number of women who never returned to the clinic (overall 14% among the four methods under evaluation); consequently the pregnancy rate could be different. Other limitations include the analysis of two kinds of copper IUD and two kinds of contraceptive implants as the same IUD or implant, and the low number of users of implants. In addition, the DALY calculation relies on a number of estimates, which may vary in different parts of the world. LARC methods and DMPA are highly effective and women who were well-counselled used these methods for a long time. The benefit of averting maternal morbidity and mortality, child mortality, and unsafe abortions is an example to health policy makers to implement more family planning programmes and to offer contraceptive methods, mainly LARC and DMPA, at no cost or at affordable cost for the underprivileged population. This study received partial financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), grant # 2012/12810-4 and from the National Research Council (CNPq), grant #573747/2008-3. B.F.B., M.P.G., and V.M.C. were fellows from the scientific initiation programme from FAPESP. Since the year 2001, all the TCu380A IUD were donated by Injeflex, São Paulo, Brazil, and from the year 2006 all the LNG-IUS were donated by the International Contraceptive Access Foundation (ICA), Turku, Finland. Both donations are as unrestricted grants. The authors declare that there are no conflicts of interest associated with this study.

Interplay Between Cell Growth And Cell Cycle In Plants.

The growth of organs and whole plants depends on both cell growth and cell-cycle progression, but the interaction between both processes is poorly understood. In plants, the balance between growth and cell-cycle progression requires coordinated regulation of four different processes: macromolecular synthesis (cytoplasmic growth), turgor-driven cell-wall extension, mitotic cycle, and endocycle. Potential feedbacks between these processes include a cell-size checkpoint operating before DNA synthesis and a link between DNA contents and maximum cell size. In addition, key intercellular signals and growth regulatory genes appear to target at the same time cell-cycle and cell-growth functions. For example, auxin, gibberellin, and brassinosteroid all have parallel links to cell-cycle progression (through S-phase Cyclin D-CDK and the anaphase-promoting complex) and cell-wall functions (through cell-wall extensibility or microtubule dynamics). Another intercellular signal mediated by microtubule dynamics is the mechanical stress caused by growth of interconnected cells. Superimposed on developmental controls, sugar signalling through the TOR pathway has recently emerged as a central control point linking cytoplasmic growth, cell-cycle and cell-wall functions. Recent progress in quantitative imaging and computational modelling will facilitate analysis of the multiple interconnections between plant cell growth and cell cycle and ultimately will be required for the predictive manipulation of plant growth.

Predictors Of Silent Myocardial Ischemia In Resistant Hypertensive Patients.

Hypertension is the most prevalent and significant modifiable risk factor for coronary heart disease. A portion of patients with uncontrolled hypertension are considered to have resistant hypertension (RHTN). Myocardial ischemia incidence increases along with blood pressure (BP) levels. However, the prevalence of myocardial ischemia in patients with RHTN, as well as the factors associated with it, is unknown. We enrolled 129 patients with true RHTN regularly followed in our specialty hypertension clinic and evaluated then by resting and dipyridamole pharmacological stress myocardial perfusion scintigraphy. Patients were then divided into 2 groups: those with (I-RHTN; n = 36) and those without (NI-RHTN; n = 93) myocardial ischemia. Echocardiography, 24-hour ambulatory BP monitoring (ABPM), and flow mediated dilation (FMD) were also evaluated. Thirty six (28%) patients had myocardial ischemia. There was no difference between groups regarding age, sex, biochemical parameters, office, and 24-hour ABPM levels. Patients in the I-RHTN group were more likely diabetic (31% vs. 11%; P < 0.05) and obese (75% vs. 40%; P < 0.001). Adjusting for age and body mass index, multiple logistic regression showed that diabetes (odds ratio (OR) = 6.5; 95% confidence interval (CI) = 1.06-40.14; P = 0.04), FMD (OR = 0.18; 95% CI = 0.07-0.41; P < 0.001), heart rate (OR = 1.23; 95% CI = 1.11-1.36; P < 0.001), left ventricular mass index (OR = 1.02; 95% CI = 1.01-1.04; P = 0.04), and microalbuminuria (OR = 1.02; 95% CI = 1.01-1.04; P = 0.002) were independent predictors of ischemia. In conclusion, there is a high prevalence of myocardial ischemia in patients with RHTN. Increased microalbuminuria, heart rate, endothelial dysfunction, and left ventricular mass can be useful to guide the investigation for myocardial ischemia in these high risk patients.

Environmental Controls In The Water Use Patterns Of A Tropical Cloud Forest Tree Species, Drimys Brasiliensis (winteraceae).

Trees from tropical montane cloud forest (TMCF) display very dynamic patterns of water use. They are capable of downwards water transport towards the soil during leaf-wetting events, likely a consequence of foliar water uptake (FWU), as well as high rates of night-time transpiration (Enight) during drier nights. These two processes might represent important sources of water losses and gains to the plant, but little is known about the environmental factors controlling these water fluxes. We evaluated how contrasting atmospheric and soil water conditions control diurnal, nocturnal and seasonal dynamics of sap flow in Drimys brasiliensis (Miers), a common Neotropical cloud forest species. We monitored the seasonal variation of soil water content, micrometeorological conditions and sap flow of D. brasiliensis trees in the field during wet and dry seasons. We also conducted a greenhouse experiment exposing D. brasiliensis saplings under contrasting soil water conditions to deuterium-labelled fog water. We found that during the night D. brasiliensis possesses heightened stomatal sensitivity to soil drought and vapour pressure deficit, which reduces night-time water loss. Leaf-wetting events had a strong suppressive effect on tree transpiration (E). Foliar water uptake increased in magnitude with drier soil and during longer leaf-wetting events. The difference between diurnal and nocturnal stomatal behaviour in D. brasiliensis could be attributed to an optimization of carbon gain when leaves are dry, as well as minimization of nocturnal water loss. The leaf-wetting events on the other hand seem important to D. brasiliensis water balance, especially during soil droughts, both by suppressing tree transpiration (E) and as a small additional water supply through FWU. Our results suggest that decreases in leaf-wetting events in TMCF might increase D. brasiliensis water loss and decrease its water gains, which could compromise its ecophysiological performance and survival during dry periods.

Avaliação do estado nutricional dos idosos residentes em Fortaleza/CE: o uso de diferentes indicadores antropométricos

O objetivo deste estudo foi avaliar, utilizando diferentes indicadores antropométricos, o estado nutricional dos idosos de Fortaleza. Este estudo é de base populacional, do tipo transversal, com coleta de dados primários. As variáveis antropométricas analisadas foram: índice de massa corporal (IMC), dobra cutânea tricipital (DCT) e circunferência muscular do braço (CMB). O estado nutricional foi definido a partir dos diagnósticos obtidos com a análise das variáveis antropométricas: eutrófico (idoso, no qual as três variáveis antropométricas (IMC, DCT e CMB), simultaneamente, indicassem o estado de eutrofia, segundo os padrões adotados) e não eutrófico (demais idosos). Foram selecionados 385 domicílios para comporem a amostra deste estudo, nos quais foram entrevistados 483 idosos (68% mulheres). Quanto ao IMC, 47,3% do total de idosos foram considerados eutróficos. As mulheres apresentaram maior proporção de valores de IMC excessivo (21,9%), quando comparadas aos homens (13,5%). Foi verificada associação estatisticamente significativa entre adequação de IMC e sexo. Os valores de DCT mostraram que 54,4% do total de idosos eram eutróficos. Não houve associação estatisticamente significativa entre a adequação da DCT e sexo. Quanto à CMB, os homens apresentaram maior prevalência de desnutrição (66,5%), quando comparados às mulheres (40,6%). Foi verificada associação estatisticamente significativa entre adequação da CMB e sexo. Ao verificar o estado nutricional por meio das variáveis antropométricas, observou-se que 83,9% dos homens foram considerados não eutróficos, assim como maior parte das mulheres (74,2%). Foi observada associação estatisticamente significativa entre estado nutricional e sexo. Os idosos de Fortaleza apresentam estado nutricional vulnerável, visto as prevalências de não eutróficos

Electromagnetic Wave Scattering by Schwarzschild Black Holes

We analyze the scattering of a planar monochromatic electromagnetic wave incident upon a Schwarzschild black hole. We obtain accurate numerical results from the partial wave method for the electromagnetic scattering cross section and show that they are in excellent agreement with analytical approximations. The scattering of electromagnetic waves is compared with the scattering of scalar, spinor, and gravitational waves. We present a unified picture of the scattering of all massless fields for the first time.

Overview: The effect of affect in organizational settings

Nine of the chapters in this volume were sourced from the Fourth International Conference on Emotions and Organizational Life, held at Birkbeck College, London, in June 2004, and attended by 77 delegates. A record 46 papers were submitted to the conference, of which 27 were selected for presentation, in addition to one symposium. The nine papers chosen for this book were selected on the basis of their quality, interest, and appropriateness for the theme of this volume, “The effect of affect in organizational settings.” (A further set of papers has been selected to appear in Volume 2 of this book series.) We acknowledge in particular the assistance of the conference paper reviewers (see Appendix), who returned high-quality reviews in a very short time.

Overview: Individual and organizational perspectives on emotion management and display

As reported in Volume 1 of Research on Emotions in Organizations (Ashkanasy, Zerbe, & Härtel, 2005), the chapters in this volume are drawn from the best contributions to the 2004 International Conference on Emotion and Organizational Life held at Birkbeck College, London, complemented by additional, invited chapters. (This biannual conference has come to be known as the “Emonet” conference, after the listserv of members.) Previous edited volumes (Ashkanasy, Härtel, & Zerbe, 2000; Ashkanasy, Zerbe, & Härtel, 2002; Härtel, Zerbe, & Ashkanasy, 2004) were published every two years following the Emonet conference. With the birth of this annual Elsevier series came the opportunity for greater focus in the theme of each volume, and for greater scope for invited contributions. This volume contains eight chapters selected from conference contributions for their quality, interest, and appropriateness to the theme of this volume, as well as four invited chapters. We again acknowledge in particular the assistance of the conference paper reviewers (see the appendix). In the year of publication of this volume the 2006 Emonet conference will be held in Atlanta, USA and will be followed by Volumes 3 and 4 of Research on Emotions in Organizations. Readers interested in learning more about the conferences or the Emonet list should check the Emonet website http://www.uq.edu.au/emonet/.

Impact of Commercial Search Engines and International Databases on Engineering Teaching and Research

For the last three decades, the engineering higher education and professional environments have been completely transformed by the "electronic/digital information revolution" that has included the introduction of personal computer, the development of email and world wide web, and broadband Internet connections at home. Herein the writer compares the performances of several digital tools with traditional library resources. While new specialised search engines and open access digital repositories may fill a gap between conventional search engines and traditional references, these should be not be confused with real libraries and international scientific databases that encompass textbooks and peer-reviewed scholarly works. An absence of listing in some Internet search listings, databases and repositories is not an indication of standing. Researchers, engineers and academics should remember these key differences in assessing the quality of bibliographic "research" based solely upon Internet searches.

Beyond essentialism

This is a rather rough draft of a reworked version of my earlier paper on women in engineering. I am interested to hear how the new argument strikes you (rather than micro comment). You may post commented-on papers here or send them to me by email. If you want to post comments but don't want everyone to see your comments you can restrict access.

Programming internet based DAI applications in Qu-Prolog

This paper presents the unique collection of additional features of Qu-Prolog, a variant of the Al programming language Prolog, and illustrates how they can be used for implementing DAI applications. By this we mean applications comprising communicating information servers, expert systems, or agents, with sophisticated reasoning capabilities and internal concurrency. Such an application exploits the key features of Qu-Prolog: support for the programming of sound non-clausal inference systems, multi-threading, and high level inter-thread message communication between Qu-Prolog query threads anywhere on the internet. The inter-thread communication uses email style symbolic names for threads, allowing easy construction of distributed applications using public names for threads. How threads react to received messages is specified by a disjunction of reaction rules which the thread periodically executes. A communications API allows smooth integration of components written in C, which to Qu-Prolog, look like remote query threads.

Factors affecting management decisions in rectal cancer in clinical practice: results from a national survey

Management of rectal cancer has become increasingly complex and a multidisciplinary approach is considered of key importance for improving outcomes. A national survey among specialists involved in this multidisciplinary setting was performed. A web-based survey containing 11 questions regarding rectal cancer management was sent to surgeons and medical oncologists registered by their corresponding societies as members. Statistical analysis was performed using the chi-square and Fisher`s exact tests for all categorical variables according to response to individual questions. Multivariate analysis was performed using Cox`s logistic regression. Overall, 418 email recipients responded the survey. Local staging was performed without either magnetic resonance imaging or endorectal ultrasound by 64% of responders. Seventy-two percent considered that final management decision should be made after neoadjuvant chemoradiation therapy. Additionally, 46% considered that an alternative procedure (local excision or observation) was appropriate in a patient with a complete clinical response. Colorectal surgeons were more frequently in favor of longer intervals after completion of chemoradiation therapy (P = 0.001) and of alternative management procedures after a complete clinical response (P = 0.02). After multivariate analysis, the choice of a watch and wait approach after a complete clinical response following neoadjuvant chemoradiation therapy was significantly more frequent among surgeons (OR 3.5, 95% CI 1.8-7.1). Surgeons seem to be more in favor of tailoring management of rectal cancer according to tumor response after neoadjuvant chemoradiation therapy, with longer intervals after chemoradiation therapy, decisions about treatment strategy being made after chemoradiation therapy instead of before, and the use of alternative surgical procedures after a complete clinical response following neoadjuvant therapy.

Conclusion

Teleneurology is the use of telecommunications to improve the delivery of neurology services. A wide range of telecommunications techniques may be used, including the telephone, email, the Internet and videoconferencing. Teleneurology can improve access to specialist neurological services for patients all over the world. Teleneurology also deals with more specialized fields that are of interest to the neurological practitioner, such as neurophysiology and neuroradiology. The book combines comprehensive reviews of each topic with practical advice on all available telemedicine techniques and on navigating the Internet for the most up-to-date neurological information. The fifth in a line of best selling telemedicine titles edited by Richard Wootton, Teleneurology is written by experts from four continents, providing a succinct introduction to teleneurology. It should prove invaluable for practising neurologists in particular, but also for general practitioners, paramedical staff, health service managers and IT staff. [via]

Experience with a low-cost telemedicine system in three developing countries

The Swinfen Charitable Trust was established in 1998 with the aim of helping the poor, sick and disabled in the developing world. It does this by setting up simple telemedicine links based on email to support doctors in isolated hospitals. The first telemedicine link was established to support the lone orthopaedic surgeon at the Centre for the Rehabilitation of the Paralysed (CRP) in Savar, near Dhaka in Bangladesh, in July 1999. An evaluation of the 27 referrals made during the first year of operation showed that the telemedical advice had been useful and cost-effective. Based on the success of the Bangladesh project, the Swinfen Charitable Trust supplied: digital cameras and tripods to more hospitals in other developing countries. These are Patan Hospital in Nepal (March 2000), Gizo Hospital in the Solomon Islands (March 2000), Helena Goldie Hospital: on New Georgia in the Solomon Islands (September 2000) and LAMB Hospital in Bangladesh (September 2000).