Influence of Assisted Reproductive Techniques in the occurrence of weight discordance in twin gestations

Background:There is no actual evidence that the ART are directly related to the occurrence of weight discordance. In some studies, ART-­‐conceived twin pregnancies are at greater risk than non-­‐ART-­‐conceived ones for pregnancy complications and adverse perinatal outcome: the incidences of pregnancy-­‐induced hypertension, uterine bleeding, premature contractions, IUGR, fetal death, discordance, and cesarean section were significantly higher. Discordance rate was elevated (25.3% vs.17.0%) among ART twins, which can increase perinatal risk (increased incidence of SGA and NICU admission). Other studies say that perinatal and neonatal morbidity, gestational age at delivery, and birth weight are not affected by ART. Regarding the first trimester ultrasound, some studies didn’t notice significant differences in CRL disparity or birth weight discordance between spontaneous and ART-­‐ conceived dichorionic twin pregnancies. In ART-­‐conceived dichorionic twin pregnancies, CRL disparity may be associated with birth weight discordance. In some studies, CRL discordance in twin pregnancies in the first trimester was a frequent finding. Objectives: To analyze the association of the ART in the occurrence of weight discordance in the pregnancies between 2010 and 2013 in the Hospital Universitari de Girona Doctor Josep Trueta, and to describe the proportion of diagnosis of growth discordance in the first trimester by the ultrasonography technology. Methods: A retrospective cohort study will be performed in those patients with twin pregnancies between 2010 and 2013, within the Hospital Universitari de Girona Doctor Josep Trueta (HUJT). A retrospective and descriptive study will be done in those cases with discordance weight in the moment of the birth, in which the CRL will be studied in the first trimester ultrasound, describing the percentage of discordance detected in that moment. The general characteristics of the sample are going to be analyzed by Logistic RegressionInfluenceof

Influence of Assisted Reproductive Techniques in the occurrence of weight discordance in twin gestations

Background:There is no actual evidence that the ART are directly related to the occurrence of weight discordance. In some studies, ART-­‐conceived twin pregnancies are at greater risk than non-­‐ART-­‐conceived ones for pregnancy complications and adverse perinatal outcome: the incidences of pregnancy-­‐induced hypertension, uterine bleeding, premature contractions, IUGR, fetal death, discordance, and cesarean section were significantly higher. Discordance rate was elevated (25.3% vs.17.0%) among ART twins, which can increase perinatal risk (increased incidence of SGA and NICU admission). Other studies say that perinatal and neonatal morbidity, gestational age at delivery, and birth weight are not affected by ART. Regarding the first trimester ultrasound, some studies didn’t notice significant differences in CRL disparity or birth weight discordance between spontaneous and ART-­‐ conceived dichorionic twin pregnancies. In ART-­‐conceived dichorionic twin pregnancies, CRL disparity may be associated with birth weight discordance. In some studies, CRL discordance in twin pregnancies in the first trimester was a frequent finding. Objectives: To analyze the association of the ART in the occurrence of weight discordance in the pregnancies between 2010 and 2013 in the Hospital Universitari de Girona Doctor Josep Trueta, and to describe the proportion of diagnosis of growth discordance in the first trimester by the ultrasonography technology. Methods: A retrospective cohort study will be performed in those patients with twin pregnancies between 2010 and 2013, within the Hospital Universitari de Girona Doctor Josep Trueta (HUJT). A retrospective and descriptive study will be done in those cases with discordance weight in the moment of the birth, in which the CRL will be studied in the first trimester ultrasound, describing the percentage of discordance detected in that moment. The general characteristics of the sample are going to be analyzed by Logistic RegressionInfluenceof

Ebola Information for West Africans Living in the United States, November 14, 2014

West Africans in the United States may face negative responses from people in their community because of the current Ebola outbreak. People may say bad things about you, or try to stop you or your family from everyday activities like work, school, shopping, or spending time with friends. This is known as stigma. Stigma mostly occurs because of fear—people fear Ebola and the disease is linked with a specific region of the world. You are not more at risk for Ebola because of your specific race or country of origin.

A partial ordering of knots and links through diagrammatic unknotting

In this paper we de. ne a partial ordering of knots and links using a special property derived from their minimal diagrams. A link K' is called a predecessor of a link K if Cr(K') < Cr(K) and a diagram of K' can be obtained from a minimal diagram D of K by a single crossing change. In such a case, we say that K' < K. We investigate the sets of links that can be obtained by single crossing changes over all minimal diagrams of a given link. We show that these sets are specific for different links and permit partial ordering of all links. Some interesting results are presented and many questions are raised.

Influence of Assisted Reproductive Techniques in the occurrence of weight discordance in twin gestations

Background:There is no actual evidence that the ART are directly related to the occurrence of weight discordance. In some studies, ART-­‐conceived twin pregnancies are at greater risk than non-­‐ART-­‐conceived ones for pregnancy complications and adverse perinatal outcome: the incidences of pregnancy-­‐induced hypertension, uterine bleeding, premature contractions, IUGR, fetal death, discordance, and cesarean section were significantly higher. Discordance rate was elevated (25.3% vs.17.0%) among ART twins, which can increase perinatal risk (increased incidence of SGA and NICU admission). Other studies say that perinatal and neonatal morbidity, gestational age at delivery, and birth weight are not affected by ART. Regarding the first trimester ultrasound, some studies didn’t notice significant differences in CRL disparity or birth weight discordance between spontaneous and ART-­‐ conceived dichorionic twin pregnancies. In ART-­‐conceived dichorionic twin pregnancies, CRL disparity may be associated with birth weight discordance. In some studies, CRL discordance in twin pregnancies in the first trimester was a frequent finding. Objectives: To analyze the association of the ART in the occurrence of weight discordance in the pregnancies between 2010 and 2013 in the Hospital Universitari de Girona Doctor Josep Trueta, and to describe the proportion of diagnosis of growth discordance in the first trimester by the ultrasonography technology. Methods: A retrospective cohort study will be performed in those patients with twin pregnancies between 2010 and 2013, within the Hospital Universitari de Girona Doctor Josep Trueta (HUJT). A retrospective and descriptive study will be done in those cases with discordance weight in the moment of the birth, in which the CRL will be studied in the first trimester ultrasound, describing the percentage of discordance detected in that moment. The general characteristics of the sample are going to be analyzed by Logistic RegressionInfluenceof

European Integration Without EU Membership : Models, Experiences, Perspectives

At the beginning of the 1990s, the concept of "European integration" could still be said to be fairly unambiguous. Nowadays, it has become plural and complex almost to the point of unintelligibility. This is due, of course, to the internal differentiation of EU membership, with several Member States pulling out of key integrative projects such as establishing an area without frontiers, the "Schengen" area, and a common currency. But this is also due to the differentiated extension of key integrative projects to European non-EU countries - Schengen is again a case in point. Such processes of "integration without membership", the focus of the present publication, are acquiring an ever-growing topicality both in the political arena and in academia. International relations between the EU and its neighbouring countries are crucial for both, and their development through new agreements features prominently on the continent's political agenda. Over and above this aspect, the dissemination of EU values and standards beyond the Union's borders raises a whole host of theoretical and methodological questions, unsettling in some cases traditional conceptions of the autonomy and separation of national legal orders. This publication brings together the papers presented at the Integration without EU Membership workshop held in May 2008 at the EUI (Max Weber Programme and Department of Law). It aims to compare different models and experiences of integration between the EU, on the one hand, and those European countries that do not currently have an accession perspective on the other hand. In delimiting the geographical scope of the inquiry, so as to scale it down to manageable proportions, the guiding principles have been to include both the "Eastern" and "Western" neighbours of the EU, and to examine both structured frameworks of cooperation, such as the European Neighbourhood Policy and the European Economic Area, and bilateral relations developing on a more ad hoc basis. These principles are reflected in the arrangement of the papers, which consider in turn the positions of Ukraine, Russia, Norway, and Switzerland in European integration - current standing, perspectives for evolution, consequences in terms of the EU-ization of their respective legal orders1. These subjects are examined from several perspectives. We had the privilege of receiving contributions from leading practitioners and scholars from the countries concerned, from EU highranking officials, from prominent specialists in EU external relations law, and from young and talented researchers. We wish to thank them all here for their invaluable insights. We are moreover deeply indebted to Marise Cremona (EUI, Law Department, EUI) for her inspiring advice and encouragement, as well as to Ramon Marimon, Karin Tilmans, Lotte Holm, Alyson Price and Susan Garvin (Max Weber Programme, EUI) for their unflinching support throughout this project. A word is perhaps needed on the propriety and usefulness of the research concept embodied in this publication. Does it make sense to compare the integration models and experiences of countries as different as Norway, Russia, Switzerland, and Ukraine? Needless to say, this list of four evokes a staggering diversity of political, social, cultural, and economic conditions, and at least as great a diversity of approaches to European integration. Still, we would argue that such diversity only makes comparisons more meaningful. Indeed, while the particularities and idiosyncratic elements of each "model" of integration are fully displayed in the present volume, common themes and preoccupations run through the pages of every contribution: the difficulty in conceptualizing the finalité and essence of integration, which is evident in the EU today but which is greatly amplified for non-EU countries; the asymmetries and tradeoffs between integration and autonomy that are inherent in any attempt to participate in European integration from outside; the alteration of deeply seated legal concepts, and concepts about the law, that are already observable in the most integrated of the non-EU countries concerned. These issues are not transient or coincidental: they are inextricably bound up with the integration of non-EU countries in the EU project. By publishing this collection, we make no claim to have dealt with them in an exhaustive, still less in a definitive manner. Our ambition is more modest: to highlight the relevance of these themes, to place them more firmly on the scientific agenda, and to provide a stimulating basis for future research and reflection.

Usabilidad de una biblioteca online con diseño centrado en el usuario

This thesis deals the aspects of usability and design of a web from a user's point of view. The thesis will examine the elements comprised in the development of a web (the human and technological aspects and how the interact). It will explain in depth how to approach these issues correctly or incorrectly, how to avoid dealing with them incorrectly and how to find a happy medium, which is as they say where the virtue lays. The thesis is completed with the practical example of a creation of a web site (the MARK'S SCIENCE on-line library).

Commentary : beyond vague causal effect estimation of obesity on health outcomes

In the current issue of epidemiology, Danaei and colleagues elegantly estimated both the direct effect and the indirect effect-that is, the effect mediated by blood pressure, cholesterol, glucose, fibrinogen, and high-sensitivity C-reactive protein-of body mass index (BMI) on the risk of coronary heart disease (CHD). they analyzed data from 9 cohort studies including 58,322 patients and 9459 CHD events, with baseline measurements between 1954 and 2001. Using sophisticated and cutting-edge methods for direct and indirect effect estimations, the authors estimated that half of the risk of overweight and obesity would be mediated by blood pressure, cholesterol, and glucose. Few additional percentage points of the risk would be mediated by fibrinogen and hs-CRP. How should we understand these estimates? Can we say that if obese persons reduce their body weight and reach a normal body weight, their excess risk of CHD would be reduced by half through an improvement in these mediators and by half through the reduction in BmI itself? Is that also true if these individuals are prevented from becoming obese in the first place? Can we also conclude that if these mediators are well controlled in obese individuals through other means than a body weight reduction, their excess risk of CHD would be reduced by half? Let us confront these estimates with observations from studies evaluating 2 interventions to reduce body weight, that is, bariatric surgery in patients with severe obesity and intensive lifestyle intervention in overweight patients with diabetes

Mothers' experience of their contact with their stillborn infant: an interpretative phenomenological analysis.

BACKGROUND: Guidelines surrounding maternal contact with the stillborn infant have been contradictory over the past thirty years. Most studies have reported that seeing and holding the stillborn baby is associated with fewer anxiety and depressive symptoms among mothers of stillborn babies than not doing so. In contrast, others studies suggest that contact with the stillborn infant can lead to poorer maternal mental health outcomes. There is a lack of research focusing on the maternal experience of this contact. The present study aimed to investigate how mothers describe their experience of spending time with their stillborn baby and how they felt retrospectively about the decision they made to see and hold their baby or not. METHOD: In depth interviews were conducted with twenty-one mothers three months after stillbirth. All mothers had decided to see and the majority to hold their baby. Qualitative analysis of the interview data was performed using Interpretive Phenomenological Analysis. RESULTS: Six superordinate themes were identified: Characteristics of Contact, Physicality; Emotional Experience; Surreal Experience; Finality; and Decision. Having contact with their stillborn infant provided mothers with time to process what had happened, to build memories, and to 'say goodbye', often sharing the experience with partners and other family members. The majority of mothers felt satisfied with their decision to spend time with their stillborn baby. Several mothers talked about their fear of seeing a damaged or dead body. Some mothers experienced strong disbelief and dissociation during the contact. CONCLUSIONS: Results indicate that preparation before contact with the baby, professional support during the contact, and professional follow-up are crucial in order to prevent the development of maternal mental health problems. Fears of seeing a damaged or dead body should be sensitively explored and ways of coping discussed. Even in cases where mothers experienced intense distress during the contact with their stillborn baby, they still described that having had this contact was important and that they had taken the right decision. This indicates a need for giving parents an informed choice by engaging in discussions about the possible benefits and risks of seeing their stillborn baby.

Engaging students in an e-learning experience : how to manage information resources through wikis and web blogs

The purpose of this paper is to describe the collaboration between librarians and scholars, from a virtual university, in order to facilitate collaborative learning on how to manage information resources. The personal information behaviour of e-learning students when managing information resources for academic, professional and daily life purposes was studied from 24 semi-structured face-to-face interviews. The results of the content analysis of the interview' transcriptions, highlighted that in the workplace and daily life contexts, competent information behaviour is always linked to a proactive attitude, that is to say, that participants seek for information without some extrinsic reward or avoiding punishment. In the academic context, it was observed a low level of information literacy and it seems to be related with a prevalent uninvolved attitude.

La humanización de las imágenens emitidas por la publicidad de los destinos monumentales: el caso de Girona

This article is based on the presentation of the results of a study on the humanisation of the image of cultural destinations, applied to the case of the city of Girona. According to the theories raised by different authors, we were interested in analyzing if the tourist images shown by the tourists publicity are influenced by romantic references typical of the dynamics of individual consumption. That is to say, if these images project a vision of an empty city, a museum.city, an individual panoramic or an individual consumption experience. The results of the analysis allow us to affirm that a mythical image of the city exists and it has a clearly romantic origin. Nevertheless, on the other hand, a specific glance exists where the tension between the indivudual freedom and the social conventionalism is demonstrated

Vortex-putken ominaisuudetkuivaussovellutuksessa

Työssä tarkastellaan vortex-putken soveltuvuutta kostean ilman kuivatukseen ja vapautuvan latenttilämmön hyödyntämiseen. Soveltuvuutta arvioidaan veden ja ilman massataseita hyväksi käyttäen ja stationaarisen systeemin energiataseen avulla. Työn mittauksia varten rakennettiin koelaitteisto, jonka avulla mitattiin miten lämpötilaerot kuumassa ja kylmässä päässä käyttäytyivät mitattaessa kuivalla ilmalla ja ilmalla, jota oli kostutettu. Mitattavia suureita olivat syöttöpaine- ja lämpötila, lämpötilat kuumassa ja kylmässä päässä, kuuman pään paine ja tilavuusvirta tai virtausnopeus ja kuuman pään suhteellinen kosteus. Mittaustulosten avulla laskettiin lämpötilan muutokset kummassakin päässä ja verrattiin kuivan ja kostean ilman mittauksien tuloksia toisiinsa. Lisäksi laskettiin tiivistyneen veden määrä ja veden ja ilman massavirrat molemmissa päissä. Näin voitiin laskea tiivistymisessä vapautuva energia ja tarkastella mihin se siirtyy. Tulosten perusteella vortex-putki soveltuu hyvin huonosti ilman kuivatukseen. Tiivistyneen veden määrä ja sitä kautta tiivistymisessä vapautunut energia, olivat pieniä. Suurin osa kosteudesta meni kuuman pään virtauksen mukana. Tiivistymisessä vapautunut energia siirtyi kylmään päähän.

Elinkaarimallin kokonaistaloudellisuus julkisten tilapalveluiden järjestämisessä

Kuntasektorin toimintaympäristön muutostenseurauksena kunnat ovat joutuneet etsimään uusia tapoja järjestää palveluita. Yksi uusista tilapalveluiden toteutusvaihtoehdoista on elinkaarimalli, jossa yksityinen sektori vastaa vähintään hankkeen suunnittelusta, rakentamisesta sekä kiinteistöpalveluista. Julkisen sektorin hankintoja säätelee hankintalaki, joka velvoittaa hyväksymään tarjouksista sen, joka on kokonaistaloudellisesti edullisin tai hinnaltaan halvin. Kaupungin näkökulmasta kokonaistaloudellisuuteen vaikuttavat tarjoushinnan lisäksi myös hankintamallien laadullisista eroista, riskien siirrosta sekä yksityisen ja julkisen sektorin välisistä kilpailueroista aiheutuvat taloudelliset vaikutukset. Tämän diplomityön tavoitteena oli rakentaa toteutusmallien vertailuun laskentamalli, jossa huomioidaan elinkaarikustannusten lisäksi muut kokonaistaloudellisuuteen vaikuttavat elementit. Aiheesta julkaistuin kirjallisuuden perusteella rakennettua teoreettista laskentamallia sovelletaan Espoossa sijaitsevaan elinkaarimallilla toteutettuun tilapalveluhankkeeseen, Kaivomestariin. Vertailua varten rakennettavalla vaihtoehtoisella toteutusmallilla, verrokkilla, kuvataan Kaivomestarin kokonaisuutta vastaavan Espoon kaupungin tavanomaisen tuotannon kustannuksia. Työn tutkimustulosten perusteella elinkaarimalli näyttää hieman tavanomaista tuotantoa kalliimmalta vaihtoehdolta järjestää tilapalveluita julkiselle sektorille. Toisaalta molemmilla toteutusmalleilla saavutetaan useita sellaisia tekijöitä, joiden taloudellisia vaikutuksia ei ole huomioitu vertailussa. Yleisesti voidaankin todeta toteutusmallien vertailun olevan erittäin vaikeaa ja haastavaa, eikä tulosten perusteella toteutusmalleja voida täysin yksiselitteisesti ja luotettavasti asettaa kokonaistaloudelliseen edullisuusjärjestykseen.

Tukki- ja parruoptimoinnintoimivuuden kehittäminen

Diplomityön tutkimusfunktio käsittelee toimeksiantajan, Stora Enso Timber Oy Ltd Kotkan sahan, sahalinjan optimointikokonaisuuden relevanttia ongelmakenttää. Tutkimuksen alussa profiloivan sahalinjan tukinpyörityksen, pelkan sivuttaissiirron tai sivulautaoptimoinnin toimivuudesta ei ollut varmuutta. Työn painopistealue on sivulautaoptimointi, jonka toimivuus tutkimuksen alussa on hyvin kyseenalaista tuotantoajossa. Työn tavoitteet kiteytyvät paremman raaka-aineen käyttösuhteen saavuttamiselle, jolloin pitkän aikajänteen kannattavuus on realistisempaa saavuttaa. Kotkan sahalinjan optimointijärjestelmässä on kokonaisuudessaan saavutettu tuotantoajoon hyväksyttävä taso. Tukinpyörityksen tarkkuudessa saavutettiin asetettu tavoite, eli 90 % pyöritystuloksista menee virheikkunaan ± 10° , sekä virheen keskiarvon itseisarvo jasen ympärillä olevan hajonnan summa on maksimissaan 10° . Pelkan sivuttaissiirto todettiin tutkimuksessa sekundääriseksi optimointijärjestelmäksi. Ohjaus perustuu tukkimittarin mittaamaan dataan, jolloin tukinpyörityksen hajonta aiheuttaa epätarkkuutta pelkan suuntauksessa. Pelkan sivuttaisiirron käyttäminen vaatii lisämittauksia, jolloin voidaan varmistua pelkan suuntauksen optimoinnin toimivuudesta. Sivulautaoptimoinnin toimivuuden kehittämisessä saavutettiin se taso, missä todellista kehitystyötä voidaan tehdä. Koeajoissa ja optimointiohjelman tarkastamisessa havaittiin periaatteellisia virheitä, jotka korjattiin. Toimivan sivulautaoptimoinnin myötä on mahdollista hallita paremmin tuotannonohjaus, jolloin tuotanto voidaan etenkin sivulautojen osalta kohdentaa paremmin vastaamaan kysyntää sekä asete-erän hyvää käyttösuhdetta. Raaka-aineen käyttösuhde on parantunut. Yksittäisten asetevertailujen sekä esimerkkilaskelmien perusteella tuottopotentiaali tukinpyörityksen ja sivulautaoptimoinnin osalta on 0,6...1,5 MEUR Välillinen tuottopotentiaali on suurempi, koska tuotantoprosessi sahauksen osalta on erittäin joustava markkinoiden tarpeen muutoksille. Sahalinjalla on mahdollista tuottaa helposti laajalla tukkisumalla laajaa tuotematriisia, jossa sivulautaoptimoinnilla on avainrooli. Tuotannonsuunnittelufunktiota tulee kehittää vastaamaan mahdollisuuksiin,joita sivulautaoptimointi tarjoaa. Tuotematriisi ja sitä vastaavat asetteet lankeavalla tukkisumalla tulee rakentaa uudestaan niiltä osin, joihin sivulautaoptimointi antaa variaatiomahdollisuuksia.

Toimintolaskennan hyväksikäyttö talouspalvelukeskuksen kustannusten kohdentamisessa

Tässä tutkimuksessa tutkittiin kustannuslaskennan,erityisesti toimintolaskennan hyväksikäyttöä talouspalvelukeskuksen kustannusten jakamisessa asiakasyhtiöille. Tavoitteena oli saada aikaan mahdollisimman selkeä, mutta kuitenkin riittävän yksinkertainen järjestelmä, jolla talouspalvelukeskuksen kustannukset kohdistetaan asiakkaille. Toinen päätavoite oli selvittää, soveltuuko toimintolaskenta talouspalvelukeskuksen tai palveluyrityksen kustannuslaskenta järjestelmäksi. Teoriaosassa on useita eri teoreettisia lähtökohtia kustannusten jakamiseen. Teoriaa on perinteisestä kustannuslaskennasta, toimintolaskennasta, laatukustannuslaskennasta ja siirtohinnoittelusta. Pääpaino on toimintolaskennassa, erityisesti toimintolaskennan hyväksikäytöstä palveluyrityksissä. Empiriaosuudessa näistä teoreettisista raameista rakennetaan malli, jolla kohdeyrityksen, Finnair Financial Services yksikön kustannukset jaetaan konsernin yhtiöille, talouspalvelukeskuksen asiakkaille. Syntynyt malli on pääpiirteissään perinteistä kustannuslaskentaa, lisäyslaskentaa Vaikka toimintolaskenta teoreettisesti soveltuu yhtä hyvin niin palvelu kuin valmistusyrityksiinkin, se ei sovellu pienille yksiköille. Tämän tutkimuksen tuloksena voidaan todeta, että toimintolaskentajärjestelmä on liian raskas talouspalvelukeskuksille ja tilitoimistotyyppisille yksiköille ja yrityksille, mutta muuten soveltuu hyvin suurten yleiskustannusten jakamiseen. Kohdeyksikössä on noin 50 työtekijää ja toimintolaskennan rakentaminen tähän yksikköön ei ole taloudellisesti järkevää. Toimintolaskennan soveltuvuudesta tai soveltumattomuudesta palveluyrityksiin ei voi tämän tutkimuksen perusteella ottaa kantaa.