Amningsduration vid sectio och vaginalförlossning : Breastfeeding duration at cesarean section and vaginal delivery. Apopulationbased register study.

Bakgrund: Amning är av stor betydelse för det nyfödda barnet och mamma, både ur närings- och trygghetsaspekter. Tidigare studier om sambandet mellan förlossningssätt och amning visar motstridiga resultat; vissa studier indikerar att sectio påverkar amningen negativt medan andra studier inte visar på något samband.Syftet: Att undersöka huruvida det finns demografiska och hälsorelaterade skillnader hos mammor gällande förlossningssätt samt om förlossningssätt påverkar amningsdurationen upp till två månaders ålder.Metod: Studien har en populationsbaserad kohortdesign och omfattar n= 35250 mamma-barn par i Örebro- och Uppsala län, där barnet fötts åren 1993-2001. Statistiska analyser har genomförts med Chi-square test, binär logistisk regressionsanalys och multivariat logistik regressionsanalys.Resultat: Visade att mammor som förlösts med sectio ammade i lägre utsträckning vid två månaders ålder i jämförelse med mammor som förlösts vaginalt. Många riskfaktorer identifierades för en ökad risk att förlösas med sectio: län, hälsofaktorer hos mamma och barn, paritet, mammans ålder, rökning samt socioekonomiska faktorer. Resultatet kan hjälpa barnmorskan i hennes profession, genom att kunskap erhålls om dessa samband. Barnmorskan kan därmed identifiera riskfaktorer, arbeta förebyggande och underlätta initieringen av amning.Konklusion: Barnmorskor kan med hjälp av denna studie öka medvetenheten hos vårdpersonal angående sectioförlösta mammors behov av extra stöd vid initiering av amning.

Passive crosslaminated timber buildings : Final report Cerbof-project no. 76

In this project, Stora Enso’s newly developed building system has been further developed to allow building to the Swedish passive house standard for the Swedish climate. The building system is based on a building framework of CLT (Cross laminated timber) boards. The concept has been tested on a small test building. The experience gained from this test building has also been used for planning a larger building (two storeys with the option of a third storey) with passive house standard with this building system. The main conclusions from the project are:  It is possible to build airtight buildings with this technique without using traditional vapour barriers. Initial measurements show that this can be done without reaching critical humidity levels in the walls and roof, at least where wood fibre insulation is used, as this has a greater capacity for storing and evening out the moisture than mineral wool. However, the test building has so far not been exposed to internal generation of moisture (added moisture from showers, food preparation etc.). This needs to be investigated and this will be done during the winter 2013-14.  A new fixing method for doors and windows has been tested without traditional fibre filling between them and the CLT panel. The door or window is pressed directly on to the CLT panel instead, with an expandable sealing strip between them. This has been proved to be successful.  The air tightness between the CLT panels is achieved with expandable sealing strips between the panels. The position of the sealing strips is important, both for the air tightness itself and to allow rational assembly.  Recurrent air tightness measurements show that the air tightness decreased somewhat during the first six months, but not to such an extent that the passive house criteria were not fulfilled. The reason for the decreased air tightness is not clear, but can be due to small movements in the CLT construction and also to the sealing strips being affected by changing outdoor temperatures.  Long term measurements (at least two years) have to be carried out before more reliable conclusions can be drawn regarding the long term effect of the construction on air tightness and humidity in the walls.  An economic analysis comparing using a concrete frame or the studied CLT frame for a three storey building shows that it is probably more expensive to build with CLT. For buildings higher than three floors, the CLT frame has economic advantages, mainly because of the shorter building time compared to using concrete for the frame. In this analysis, no considerations have been taken to differences in the influence on the environment or the global climate between the two construction methods.

Maternal health care professionals perspective on the provision and use of antenatal and delivery care : a qualitative descriptive study in rural Vietnam

Background. High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.

Image processing technique to count the number of logs in a timber truck

This paper summarises the results of using image processing technique to get information about the load of timber trucks before their arrival using digital images or geo tagged images. Once the images are captured and sent to sawmill by drivers from forest, we can predict their arrival time using geo tagged coordinates, count the number of (timber) logs piled up in a truck, identify their type and calculate their diameter. With this information we can schedule and prioritise the inflow and unloading of trucks in the light of production schedules and raw material stocks available at the sawmill yard. It is important to keep all the actors in a supply chain integrated coordinated, so that optimal working routines can be reached in the sawmill yard.   

December 1999: Public Services; Library Facelift; Book Sale

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Sale of credit portfolio and risk : the case of financial institutions in Brazil

Este estudo analisa se as vendas de carteiras de crédito são utilizadas por instituições financeiras para gestão de risco, de acordo com Stanton(1998) e Murray(2001) ou para captação recursos, como apontado em Cebenoyan e Strahan(2001) e Dionne e Harchaoui(2003). Duas hipóteses foram testadas quanto às vendas de carteira de crédito: 1) implicam em melhor rating na carteira remanescente; ou 2) promovem alavancagem financeira - com piora na carteira remanescente -, controlando para a existência de coobrigação e para quem esses ativos foram transferidos. A amostra inclui informações trimestrais de 145 instituições financeiras do primeiro trimestre de 2001 ao segundo trimestre de 2008. Os resultados oferecem evidências empíricas de que as instituições financeiras utilizam estas vendas para melhora do rating da carteira de crédito remanescente, ou seja, elas transferem, em sua maioria, ativos de baixa qualidade, garantindo bons ratings e melhorando a liquidez. Adicionalmente, seguindo a proposta Dionne e Harchaoui(2003) - que além de testar, evidenciam que exigências regulatórias promovem alavancagem em ativos de alto risco - foi observada a relação entre o Índice de Basiléia e rating da carteira de crédito. As conclusões foram semelhantes às encontradas por Dionne e Harchaoui(2003): quanto mais adequada – maior Índice de Basiléia - uma instituição financeira for, maiores as chances de ela possuir uma carteira de crédito com qualidade ruim.

Análise dos fundamentos do modelo value-based health care delivery à luz das teorias de estratégia

O setor de saúde, globalmente, apresenta problemas relacionados aos seus custos, qualidade e acesso. Porter e Teisberg (2004, 2006) propuseram modelo de gestão específico para a administração estratégica na área, o Value-Based Health Care Delivery (VBHCD). O modelo teve relativa repercussão e vem influenciando muitos atores no setor. Contudo, o modelo vem sendo aceito sem o devido questionamento de seus fundamentos e consistência com a teoria em estratégia. O presente trabalho busca, por meio de um ensaio teórico, analisar o modelo proposto à luz de paradigmas gerais da estratégia empresarial como, por exemplo, o modelo de Porter e a Visão Baseada em Recursos (RBV). Inicialmente, o artigo sintetiza as explicações teóricas do modelo porteriano clássico e da RBV. Em seguida, o VBHCD é examinado comparado a essas explicações, buscando-se relações e, eventualmente, contradições. Conclui-se que o modelo VBHCD não se alinha integralmente a nenhum corpo teórico isoladamente. Mesmo sendo proposto por Porter, parte de seus fundamentos advém, na verdade, de outras correntes teóricas. Esta abordagem integradora de teorias concorrentes, apesar de presente na literatura, ainda apresenta dificuldades e barreiras, um aspecto que não está explícito no modelo

Functionalization of dendrimers for improved gene delivery to mesenchymal stem cell

Disease, injury, and age problems compromise human quality of life and continuously motivate the search for new and more efficacious therapeutic approaches. The field of Tissue Regeneration and Engineering has greatly evolved over the last years, mainly due to the combination of the important advances verified in Biomaterials Science and Engineering with those of Cell and Molecular Biology. In particular, a new and promising area arose – Nanomedicine – that takes advantage of the extremely small size and especial chemical and physical properties of Nanomaterials, offering powerful tools for health improvement. Research on Stem Cells, the self-renewing progenitors of body tissues, is also challenging to the medical and scientific communities, being expectable the appearance of new and exciting stem cell-based therapies in the next years. The control of cell behavior (namely, of cell proliferation and differentiation) is of key importance in devising strategies for Tissue Regeneration and Engineering. Cytokines, growth factors, transcription factors and other signaling molecules, most of them proteins, have been identified and found to regulate and support tissue development and regeneration. However, the application of these molecules in long-term regenerative processes requires their continuous presence at high concentrations as they usually present short half-lives at physiological conditions and may be rapidly cleared from the body. Alternatively, genes encoding such proteins can be introduced inside cells and be expressed using cell’s machinery, allowing an extended and more sustained production of the protein of interest (gene therapy). Genetic engineering of stem cells is particularly attractive because of their self-renewal capability and differentiation potential. For Tissue Regeneration and Engineering purposes, the patient’s own stem cells can be genetically engineered in vitro and, after, introduced in the body (with or without a scaffold) where they will not only modulate the behavior of native cells (stem cell-mediated gene therapy), but also directly participate in tissue repair. Cells can be genetically engineered using viral and non-viral systems. Viruses, as a result of millions of years of evolution, are very effective for the delivery of genes in several types of cells, including cells from primary sources. However, the risks associated with their use (like infection and immunogenic reactions) are driving the search for non-viral systems that will efficiently deliver genetic material into cells. Among them, chemical methods that are promising and being investigated use cationic molecules as carriers for DNA. In this case, gene delivery and gene expression level remain relatively low when primary cells are used. The main goal of this thesis was to develop and assess the in vitro potential of polyamidoamine (PAMAM) dendrimers based carriers to deliver genes to mesenchymal stem cells (MSCs). PAMAM dendrimers are monodispersive, hyperbranched and nanospherical molecules presenting unique characteristics that make them very attractive vehicles for both drug and gene delivery. Although they have been explored for gene delivery in a wide range of cell lines, the interaction and the usefulness of these molecules in the delivery of genes to MSCs remains a field to be explored. Adult MSCs were chosen for the studies due to their potential biomedical applications (they are considered multipotent cells) and because they present several advantages over embryonic stem cells, such as easy accessibility and the inexistence of ethical restrictions to their use. This thesis is divided in 5 interconnected chapters. Chapter I provides an overview of the current literature concerning the various non-viral systems investigated for gene delivery in MSCs. Attention is devoted to physical methods, as well as to chemical methods that make use of polymers (natural and synthetic), liposomes, and inorganic nanoparticles as gene delivery vectors. Also, it summarizes the current applications of genetically engineered mesenchymal stem cells using non-viral systems in regenerative medicine, with special focus on bone tissue regeneration. In Chapter II, the potential of native PAMAM dendrimers with amine termini to transfect MSCs is evaluated. The level of transfection achieved with the dendrimers is, in a first step, studied using a plasmid DNA (pDNA) encoding for the β-galactosidase reporter gene. The effect of dendrimer’s generation, cell passage number, and N:P ratio (where N= number of primary amines in the dendrimer; P= number of phosphate groups in the pDNA backbone) on the level of transfection is evaluated, being the values always very low. In a second step, a pDNA encoding for bone morphogenetic protein-2, a protein that is known for its role in MSCs proliferation and differentiation, is used. The BMP-2 content produced by transfected cells is evaluated by an ELISA assay and its effect on the osteogenic markers is analyzed through several classical assays including alkaline phosphatase activity (an early marker of osteogenesis), osteocalcin production, calcium deposition and mineralized nodules formation (late osteogenesis markers). Results show that a low transfection level is enough to induce in vitro osteogenic differentiation in MSCs. Next, from Chapter III to Chapter V, studies are shown where several strategies are adopted to change the interaction of PAMAM dendrimers with MSCs cell membrane and, as a consequence, to enhance the levels of gene delivery. In Chapter III, generations 5 and 6 of PAMAM dendrimers are surface functionalized with arginine-glycine-aspartic acid (RGD) containing peptides – experiments with dendrimers conjugated to 4, 8 and 16 RGD units were performed. The underlying concept is that by including the RGD integrin-binding motif in the design of the vectors and by forming RGD clusters, the level of transfection will increase as MSCs highly express integrins at their surface. Results show that cellular uptake of functionalized dendrimers and gene expression is enhanced in comparison with the native dendrimers. Furthermore, gene expression is dependent on both the electrostatic interaction established between the dendrimer moiety and the cell surface and the nanocluster RGD density. In Chapter IV, a new family of gene delivery vectors is synthesized consisting of a PAMAM dendrimer (generation 5) core randomly linked at the periphery to alkyl hydrophobic chains that vary in length and number. Herein, the idea is to take advantage of both the cationic nature of the dendrimer and the capacity of lipids to interact with biological membranes. These new vectors show a remarkable capacity for internalizing pDNA, being this effect positively correlated with the –CH2– content present in the hydrophobic corona. Gene expression is also greatly enhanced using the new vectors but, in this case, the higher efficiency is shown by the vectors containing the smallest hydrophobic chains. Finally, chapter V reports the synthesis, characterization and evaluation of novel gene delivery vectors based on PAMAM dendrimers (generation 5) conjugated to peptides with high affinity for MSCs membrane binding - for comparison, experiments are also done with a peptide with low affinity binding properties. These systems present low cytotoxicity and transfection efficiencies superior to those of native dendrimers and partially degraded dendrimers (Superfect®, a commercial product). Furthermore, with this biomimetic approach, the process of gene delivery is shown to be cell surface receptor-mediated. Overall, results show the potential of PAMAM dendrimers to be used, as such or modified, in Tissue Regeneration and Engineering. To our knowledge, this is the first time that PAMAM dendrimers are studied as gene delivery vehicles in this context and using, as target, a cell type with clinical relevancy. It is shown that the cationic nature of PAMAM dendrimers with amine termini can be synergistically combined with surface engineering approaches, which will ultimately result in suitable interactions with the cytoplasmic membrane and enhanced pDNA cellular entry and gene expression. Nevertheless, the quantity of pDNA detected inside cell nucleus is always very small when compared with the bigger amount reaching cytoplasm (accumulation of pDNA is evident in the perinuclear region), suggesting that the main barrier to transfection is the nuclear membrane. Future work can then be envisaged based on the versatility of these systems as biomedical molecular materials, such as the conjugation of PAMAM dendrimers to molecules able to bind nuclear membrane receptors and to promote nuclear translocation.

Cell-responsive nanogels for anticancer drug delivery

One of the main goals in Nanomedicine is to create innovative drug delivery systems (DDS) capable of delivering drugs into a specific location with high efficiency. In the development of DDS, some essential properties are desired, such as biocompatibility and biodegradability. Furthermore, an ideal DDS should be able to deliver a drug in a controlled manner and minimize its side effects. These two objectives are still a challenge for researchers all around the world. Nanogels are an excellent vehicle to use in drug delivery and several other applications due to their biocompatibility. They are polymer-based networks, chemically or physically crosslinked, with at least 80-90% water in their composition. Their properties can be tuned, like the nanogel size, multifunctionality and degradability. Nanogels are capable of carrying in their interior bioactive molecules and deliver them into cells. The main objective of this project was to produce nanogels for the delivery of anticancer drugs with the ability of responding to existent stimuli inside cells (cellresponsiveness nanogels) and/or of controlled drug delivery. The nanogels were mainly based on alginate (AG), a natural biopolymer, and prepared using emulsion approaches. After their synthesis, they were used to encapsulate doxorubicin (Dox) which was chosen as a model drug. In the first part of the experimental work, disulfide-linked AG nanogels were prepared and, as expected, were redox-sensitive to a reducing environment like the intracellular medium. In the second part, AG nanogels crosslinked with both calcium ions and cationic poly(amidoamine) dendrimers were developed with improved sustained drug delivery. The prepared nanogels were characterized in terms of size, chemical composition, morphology, and drug delivery behavior (under redox/pH stimuli). The in vitro cytotoxicity of the nanogels was also tested against CAL-72 cells (an osteosarcoma cell line).

Seven stories: location based story-delivery system

Location aware content-based experiences have a substantial tradition in HCI, several projects over the last two decades have explored the association of digital media to specific locations or objects. However, a large portion of the literature has little focus on the creative side of designing of the experience and on the iterative process of user evaluations. In this thesis we present two iterations in the design and evaluation of a location based story delivery system (LBSDS), inspired by local folklore and oral storytelling in Madeira. We started by testing an already existing location based story platform, PlaceWear, with short multimedia clips that recounted local traditions and folktales, to this experience we called iLand. An initial evaluation of iLand, was conducted; we shadowed users during the experience and then they responded to a questionnaire. By analyzing the evaluation results we uncovered several issues that informed the redesign of the system itself as well as part of the story content. The outcome of this re design was the 7Stories experience. In the new experience we performed the integration of visual markers in the interface and the framing of the fragmented story content through the literary technique of the narrator. This was done aiming to improving the connection of the audience to the physical context where the experience is delivered. The 7Stories experience was evaluated following a similar methodology to the iLand evaluation but the user’s experience resulted considerably different; because of the same setting for the experience in both versions and the constancy of the most of the content across the two versions we were able to assess the specific effect of the new design and discuss its strengths and shortcomings. Although we did not run a formal and strict comparative test between the two evaluations, it is evident from the collected data how the specific design changes to our LBSDS influenced the user experience.

Cozinha da Madeira website: the online touchpoint for a sustainability oriented service of Madeira Island

Over the past several years technology has been evolving in a way that it has become crucial for most businesses and companies to have interactive technology enabled touchpoints available online. Such interactive touchpoints can be developed as mobile application, webpages, or even through social networks. In the end such touchpoints will most surely represent the most easily reachable and marketable side of the business. Today selling a product alone is no longer enough to make consumers satisfied and complete, businesses and business models are changing. Increasingly, companies are choosing to not just sell products but to combine both sale and service. These service-based approaches will provide the client with a unique and personalized experience of what the company is selling. By selling a service the company transmits values that are more complex than the simple selling of a product. A service is something immaterial, happens over time and exists in the moment of the delivery. When conceiving and designing services, the use of the new technologies becomes a crucial step in order to craft touchpoints that facilitate the whole experience cycle of the service, from attracting, orienting, interacting and retaining the client, as well as providing later support to the consumer to advocate for the service itself. This thesis reports on the design and implementation of the online touchpoint of Cozinha da Madeira, which is a service designed to support tourism, specifically promoting the discovery of tradition and landscapes in the island of Madeira. Such touchpoint developed in the form of a website, embodies completely or partially various stages of the Service Experience cycle, from attracting and connecting, orienting, interacting as well as retaining and advocating. Through this thesis we will describe the design and implementation of such touchpoint as well as the evaluation and possible future implications.