EULAR Recommendations for Women's Health and the Management of Family Planning, Assisted Reproduction, Pregnancy and Menopause in Patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome

OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. CONCLUSIONS: Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.

Audit report on the Wireless E-911 Emergency Communications Fund of the Iowa Department of Homeland Security and Emergency Management for the year ended June 30, 2015

Audit report on the Wireless E-911 Emergency Communications Fund of the Iowa Department of Homeland Security and Emergency Management for the year ended June 30, 2015

Lake Albert fisheries resources and their management strategy

Lake Albert/Mobutu lies along the Zaire-Uganda border in 43/57 per cent ratio in the faulted depression tending south-west to the north east. It is bounded by latitudes 1o0 n to 2o 20’ N and longitudes 30o 20’ to 31o 20’E. It has a width varying from 35 to 45 km (22 to 28 miles) as measured between the scarps at the lake level. It covers an area of 5600km2 and has a maximum depth of 48m. The major inflow is through the Semiliki, an outflow of Lake Edward, Muzizi and Victoria Nile draining lakes Victoria and Kyoga while the Albert Nile is the outflow. The physical, chemical and biological productivity parameters are summarized in Table 1. The scarp is steep but not sheer and there are at least 4 tracks leading down it to villages on the shore and scarp land scarp is a young one, formed as a result of earth movements of the Pleistocene times, and the numerous streams come down headlong down its thousand feet drop, more often than not in falls (Baker, 1954). Sometimes there appears to be a clean fault; and at other places there is the appearrence of step faulting, although this may be of only a superical nature .The escarpment’s composed of rocks belonging to the pre-Cambrian Basement complex of the content; but the floor of the depression is covered with young sedimentary rocks, known as kaiso beds. In their upper part these latter beds contains many pebbles; whilst low down the occurrence fossiliferous beds is sufficiently rare phenomenon in the interior plateau of Africa. The kaiso beds dated as possibly middle Pleistocene in age, are exposed in various flats on the shore, and they presumably extend under the relatively shallow waters of the lake. A feature of the shore is the development of sandpits and the enclosure of lagoons; and these can be observed in various stages of development at kaiso, Tonya, kibiro, Buhuka and above all, at Butiaba. On an island lake over 1100 km (700 miles) from the shores of the Indian Ocean one can thus study some of the shore-line phenomena usually associated with the sea- coast (Worthington, 1929). In the north, from Butiaba onwards, the flats become wider and from a continuous lowland as the lake shore curves away from the straight edge of the escarpment. At a height of just 610m (2000 feet) above sea-level, the rift valley floor at Butiaba has a mean annual temperature of 25.60c (780 f), from which there is virtually no seasonal variation; and and the mean daily range is only 6.50c (130f) (E.Afr. met. Dept.1953). With a mean annual rainfall of not much more than 762mm (309 inches) and only 92 rain days in ayear, again to judge from Butiaba, conditions in the rift valley are semi-arid; and the vegetation cover consists of grasses and scattered drought-resisting trees and bushes. Only near the stream courses does the vegetation thicken.

Small-scale fishing in Central American indigenous people: governance, tenure and sustainable management of marine resources

This research develops four case studies on small-scale fisheries in Central America located within indigenous territories. The ngöbe Bugle Conte Burica Territory in the south of Costa Rica, the Garífuna territory in nueva Armenia Honduras, the Rama territory in Nicaragua and the ngöbe Bugle territory in Bocas del Toro, Panamá. This is one of the first studies focusing on indigenous territories, artisanal fisheries and SSF guidelines. The cases are a first approach to discussing and analyzing relevant social and human rights issues related to conservation of marine resources and fisheries management in these territories. The cases discussed between other issues of interest, the relationships between marine protected areas under different governance models and issues related to the strengthening of the small-scale fisheries of these indigenous populations and marine fishing territories. They highlight sustainability, governance, land tenure and access to fishing resources, gender, traditional knowledge importance and new challenges as climate change.

Combined exposure to multiple mycotoxins in food: are we ready for risk assessment and risk management?

It is nowadays recognized that the risk of human co-exposure to multiple mycotoxins is real. In the last years, a number of studies have approached the issue of co-exposure and the best way to develop a more precise and realistic assessment. Likewise, the growing concern about the combined effects of mycotoxins and their potential impact on human health has been reflected by the increasing number of toxicological studies on the combined toxicity of these compounds. Nevertheless, risk assessment of these toxins, still follows the conventional paradigm of single exposure and single effects, incorporating only the possibility of additivity but not taking into account the complex dynamics associated to interactions between different mycotoxins or between mycotoxins and other food contaminants. Considering that risk assessment is intimately related to the establishment of regulatory guidelines, once the risk assessment is completed, an effort to reduce or manage the risk should be followed to protect public health. Risk assessment of combined human exposure to multiple mycotoxins thus poses several challenges to scientists, risk assessors and risk managers and opens new avenues for research. This presentation aims to give an overview of the different challenges posed by the likelihood of human co-exposure to mycotoxins and the possibility of interactive effects occurring after absorption, towards knowledge generation to support a more accurate human risk assessment and risk management. For this purpose, a physiologically-based framework that includes knowledge on the bioaccessibility, toxicokinetics and toxicodynamics of multiple toxins is proposed. Regarding exposure assessment, the need of harmonized food consumption data, availability of multianalyte methods for mycotoxin quantification, management of left-censored data and use of probabilistic models will be highlight, in order to develop a more precise and realistic exposure assessment. On the other hand, the application of predictive mathematical models to estimate mycotoxins’ combined effects from in vitro toxicity studies will be also discussed. Results from a recent Portuguese project aimed at exploring the toxic effects of mixtures of mycotoxins in infant foods and their potential health impact will be presented as a case study, illustrating the different aspects of risk assessment highlighted in this presentation. Further studies on hazard and exposure assessment of multiple mycotoxins, using harmonized approaches and methodologies, will be crucial towards an improvement in data quality and contributing to holistic risk assessment and risk management strategies for multiple mycotoxins in foodstuffs.

Maximizing HIV partner notification opportunities for index patients and their sexual partners in Malawi

Introduction HIV testing and counselling (HTC) is important to effect positive sexual behaviour change and is an entry point to treatment, care, and psychosocial support. One of the most practical initiatives to increase HTC is to encourage sexual partners of HIV-infected persons to test for HIV. However, partner notification strategies must be feasible in the healthcare setting and acceptable to the population. Methods We conducted a qualitative study during the pilot phase of an HIV partner notification trial to complement its assessment of feasibility and acceptability of methods of partner notification. We performed in-depth interviews with 16 consecutive HIV-positive index participants who consented and their 12 identifiable sexual partners. We also conducted two focus group discussions with healthcare workers to supplement the patient perspectives. In the main study, newly diagnosed HIV cases (index cases) were randomized to one of three methods of partner notification: passive, contract, and provider referral. Clients in the passive referral group were responsible for notifying their sexual partners themselves. Individuals in the contract referral group were given seven days to notify their partners, after which a healthcare provider contacted partners who had not reported for counselling and testing. In the provider group, a healthcare provider notified partners directly. Results Although most index participants and partners expressed a preference for passive notification, they also highlighted benefits for provider-assisted notification and the universal right for all HIV-exposed persons to know their HIV exposure and benefit from HIV testing and access antiretroviral treatment. Several participants mentioned couples counselling as a way to diffuse tension and get accurate information. All mentioned benefits to HIV testing, including the opportunity to change behaviour. Conclusions Provider-assisted partner notification is not preferred, but it is acceptable and may complement the passive method of notification. Couples counselling should also be encouraged.

Combining Collaborative Networks and Knowledge Management: The SENAI Case

Part 19: Knowledge Management in Networks

Errors in preparation and medication management in nursing professionals

The preparation and administration of medications is one of the most common and relevant functions of nurses, demanding great responsibility. Incorrect administration of medication, currently constitutes a serious problem in health services, and is considered one of the main adverse effects suffered by hospitalized patients. Objectives: Identify the major errors in the preparation and administration of medication by nurses in hospitals and know what factors lead to the error occurred in the preparation and administration of medication. Methods: A systematic review of the literature. Deined as inclusion criteria: original scientiic papers, complete, published in the period 2011 to May 2016, the SciELO and LILACS databases, performed in a hospital environment, addressing errors in preparation and administration of medication by nurses and in Portuguese language. After application of the inclusion criteria obtained a sample of 7 articles. Results: The main errors identiied in the pr eparation and administration of medication were wrong dose 71.4%, wrong time 71.4%, 57.2% dilution inadequate, incorrect selection of the patient 42.8% and 42.8% via inadequate. The factors that were most commonly reported by the nursing staff, as the cause of the error was the lack of human appeal 57.2%, inappropriate locations for the preparation of medication 57.2%, the presence of noise and low brightness in preparation location 57, 2%, professionals untrained 42.8%, fatigue and stress 42.8% and inattention 42.8%. Conclusions: The literature shows a high error rate in the preparation and administration of medication for various reasons, making it important that preventive measures of this occurrence are implemented.

Cow, farm, and herd management factors in the dry period associated with raised somatic cell counts in early lactation

This study investigated cow characteristics, farm facilities, and herd management strategies during the dry period to examine their joint influence on somatic cell counts (SCC) in early lactation. Data from 52 commercial dairy farms throughout England and Wales were collected over a 2-yr period. For the purpose of analysis, cows were separated into those housed for the dry period (6,419 cow-dry periods) and those at pasture (7,425 cow-dry periods). Bayesian multilevel models were specified with 2 response variables: ln SCC (continuous) and SCC >199,000 cells/mL (binary), both within 30 d of calving. Cow factors associated with an increased SCC after calving were parity, an SCC >199,000 cells/mL in the 60 d before drying off, increasing milk yield 0 to 30 d before drying off, and reduced DIM after calving at the time of SCC estimation. Herd management factors associated with an increased SCC after calving included procedures at drying off, aspects of bedding management, stocking density, and method of pasture grazing. Posterior predictions were used for model assessment, and these indicated that model fit was generally good. The research demonstrated that specific dry-period management strategies have an important influence on SCC in early lactation.

The role of science and technology management companies in the set-up and coordination of multi-partners scientific alliances

Mestrado em Economia e Gestão de Ciência, Tecnologia e Inovação

Memorandum of understanding between Universidad de Cuenca (Ecuador) and NHTV Breda University of Applied Sciences, Academies for Tourism, Leisure and Hotel Management & Facility Management Breda, The Netherlands

English

Social Mobility and Demand for Redistribution. A Comparative Analysis

The literature on preferences for redistribution has paid little attention to the effect of social mobility on the demand for redistribution, which is in contrast with the literature on class-voting, where studies on the effect of social mobility has been very common. Some works have addressed this issue but no systematic test of the hypotheses connecting social mobility and preferences has been done. In this paper we use the diagonal reference models to estimate the effect of origin and destination class on preferences for redistribution in a sample of European countries using data from the European Social Survey. Our findings indicate that social origin matters to a little extent to explain preferences, as newcomers tend to adopt the preferences of the destination class. Moreover, we have found only limited evidence supporting the acculturation hypothesis and not support for the status maximization hypothesis. Furthermore, the effect of social origin varies largely between countries. In a second step of the analysis we investigate what are the national factors explaining this variation. The empirical evidence we present leads to conclude that high rates of upward social mobility sharply reduce the effect of social origin on preferences for redistribution

Social Trust and Demand for Redistribution. Is There a Crowding out Effect?

The debate about the relationship between social capital the welfare state has produced contradictory results for a long time. The crowding out hypothesis states that the growth of the welfare state would erode social capital, as the action of the state leave no room for non-regulated spontaneous cooperation. In sharp contrast, the crowding in hypothesis states that there is virtuous circle between the size of the welfare state and the stock of social capital in a particular country, since generous welfare states (specially those relying on universalistic programs) will produce a particular sense of fairness and solidarity toward fellow citizens. Yet, the empirical evidence testing the explanatory power of these theories is mostly inconclusive. To further our knowledge of this puzzle, in this paper I focus specifically on the relationship between social trust and preferences for redistribution at the individual level in a sample of European countries belonging to different welfare state regimes.

Leading change in higher education. The role of transformational and stakeholder management

Summary…iii Samenvatting . iv Resumen . vii Acknowledgments ix Table of Contents. xi List of tables xiii List of figures . xiii CHAPTER I General Introduction 2 CHAPTER II Transformational leadership and stakeholder management in library change . 47 CHAPTER III Successful change: the role of transformational leadership and stakeholder management in universities ... 73 CHAPTER IV Transformational leadership and stakeholder management: A multiple case study in Latin American universities . 111 CHAPTER V General Discussion 149 APPENDIX . 169 REFERENCES . 179

Beta depicta, or, Remarks on mangel wurzel, with an exposition on its utility reduced from practical experiments, and with full directions for its culture, and the management in feeding and fattening of cattle,

Mode of access: Internet.