Risk factors for non-haemorrhagic stroke in patients with coronary heart disease and the effect of lipid-modifying therapy with pravastatin

Objective To determine the relative importance of recognised risk factors for non-haemorrhagic stroke, including serum cholesterol and the effect of cholesterol-lowering therapy, on the occurrence of non-haemorrhagic stroke in patients enrolled in the LIPID (Long-term Intervention with Pravastatin in Ischaemic Disease) study. Design The LIPID study was a placebo-controlled, double-blind trial of the efficacy on coronary heart disease mortality of pravastatin therapy over 6 years in 9014 patients with previous acute coronary syndromes and baseline total cholesterol of 4-7 mmol/l. Following identification of patients who had suffered non-haemorrhagic stroke, a pre-specified secondary end point, multivariate Cox regression was used to determine risk in the total population. Time-to-event analysis was used to determine the effect of pravastatin therapy on the rate of non-haemorrhagic stroke. Results There were 388 non-haemorrhagic strokes in 350 patients. Factors conferring risk of future non-haemorrhagic stroke were age, atrial fibrillation, prior stroke, diabetes, hypertension, systolic blood pressure, cigarette smoking, body mass index, male sex and creatinine clearance. Baseline lipids did not predict non-haemorrhagic stroke. Treatment with pravastatin reduced non-haemorrhagic stroke by 23% (P= 0.016) when considered alone, and 21% (P= 0.024) after adjustment for other risk factors. Conclusions The study confirmed the variety of risk factors for non-haemorrhagic stroke. From the risk predictors, a simple prognostic index was created for nonhaemorrhagic stroke to identify a group of patients at high risk. Treatment with pravastatin resulted in significant additional benefit after allowance for risk factors. (C) 2002 Lippincott Williams Wilkins.

Present and future pharmacotherapy for benign prostatic hyperplasia

Around 50% of men 51-60 years of age have pathological benign prostatic hyperplasia (BPH). Pharmacotherapy for BPH includes the 5alpha-reductase inhibitor finasteride, and alpha(1)-adrenoceptor antagonists. Finasteride reduces prostate volume and symptom scores, while increasing peak urinary flow rates. The main problem with finasteride treatment is that it increases the incidence of ejaculation disorders. All of the alpha(1)-adrenoceptor antagonists have been shown to reduce symptom scores and increase peak urinary flow rates in BPH. The nonselective alpha(1)-adrenoceptor antagonists (prazosin, terazosin and doxazosin) were developed as antihypertensives, and hypotensive-related side effects are the main problem with these agents in BPH. These side effects can be diminished by reducing peak concentrations of the drugs, as with once-daily alfuzosin, or by using the uroselective antagonist tamsulosin. Phytopharmaceuticals are commonly used in the treatment of BPH, such as saw palmetto berry which has been shown to improve the symptoms and peak urinary flow rate. Androgen receptor antagonists are not used in BPH because of their adverse effects. Newer drugs under development for the treatment of BPH include alpha(1)-adrenoceptor antagonists that show more selectivity for alpha(1A)-adrenoceptors than tamsulosin, combined 5alpha-reductase/alpha(1)-adrenoceptor inhibitors and combined type 1/type 2 5alpha-reductase inhibitors. New targets for the drug treatment of BPH include indothelin, growth factors, estrogens and the phosphodiesterase isoenzymes.

The effect of a triclosan-containing dentifrice on the progression of periodontal disease in an adult population

Objectives: The aim of the present study was to determine the effect of unsupervised, long-term use of a 0.3% triclosan/2% copolymer dentifrice on the progression of periodontal disease in a general adult population. Methods: Five hundred and four volunteers were enrolled in a double-blind, controlled clinical trial. Participants were matched for disease status, plaque index, age and gender. At the baseline examination, probing pocket depths and relative attachment levels were recorded and participants were assigned to either the test or control group. Re-examinations took place after 6, 12, 24, 36, 48 and 60 months. Subgingival plaque samples were collected at each examination and assayed for Porphyromonas gingivalis , Actinobacillus actinomycetemcomitans and Prevotella intermedia . A generalised linear model was used to analyse the data, with a number of covariates thought to influence the responses included as the possible confounding effects. Results: The triclosan/copolymer dentifrice had a significant effect in subjects with interproximal probing depths greater than or equal to3.5 mm, where it significantly reduced the number of sites with probing depths greater than or equal to3.5 mm at the following examination, when compared with the control group (p

Initial effects of elbow taping on pain-free grip strength and pressure pain threshold

Study design: Single-blind, placebo control, randomized, crossover, experimental Study with repeated measures, Objective: To determine the initial effects of a taping technique on grip strength and pain in individuals with lateral epicondylalgia. Background: Taping techniques are advocated for chronic musculoskeletal conditions such as lateral epicondylalgia, a prevalent disorder with significant impact on the individual and community. Little evidence exists supporting the effects of taping techniques on musculoskeletal pain. Methods and Measures: Sixteen participants (mean age +/- SD, 45.8 +/- 10.2 years) with chronic lateral epicondylalgia (rnean duration +/- SD, 13.1 +/- 9.9 months) participated in a placebo control study of an elbow taping technique. Outcome measures were pain-free grip strength and pressure pain threshold taken before, immediately after, and 30 minutes after application of tape. Results: The taping technique significantly improved pain-free grip strength by 24% from baseline (P = .028). The treatment effect was greater than that for placebo and control conditions. Changes in pressure pain threshold (19%), although positive, were not statistically significant. Conclusion: This preliminary study demonstrated an initial ameliorative effect of a taping technique for lateral epicondylalgia and suggests that it should be considered as an adjunct in the management of this condition.

Asymmetric blasting: a rock mass dependent blast design method

Blasting has been the most frequently used method for rock breakage since black powder was first used to fragment rocks, more than two hundred years ago. This paper is an attempt to reassess standard design techniques used in blasting by providing an alternative approach to blast design. The new approach has been termed asymmetric blasting. Based on providing real time rock recognition through the capacity of measurement while drilling (MWD) techniques, asymmetric blasting is an approach to deal with rock properties as they occur in nature, i.e., randomly and asymmetrically spatially distributed. It is well accepted that performance of basic mining operations, such as excavation and crushing rely on a broken rock mass which has been pre conditioned by the blast. By pre-conditioned we mean well fragmented, sufficiently loose and with adequate muckpile profile. These muckpile characteristics affect loading and hauling [1]. The influence of blasting does not end there. Under the Mine to Mill paradigm, blasting has a significant leverage on downstream operations such as crushing and milling. There is a body of evidence that blasting affects mineral liberation [2]. Thus, the importance of blasting has increased from simply fragmenting and loosing the rock mass, to a broader role that encompasses many aspects of mining, which affects the cost of the end product. A new approach is proposed in this paper which facilitates this trend 'to treat non-homogeneous media (rock mass) in a non-homogeneous manner (an asymmetrical pattern) in order to achieve an optimal result (in terms of muckpile size distribution).' It is postulated there are no logical reasons (besides the current lack of means to infer rock mass properties in the blind zones of the bench and onsite precedents) for drilling a regular blast pattern over a rock mass that is inherently heterogeneous. Real and theoretical examples of such a method are presented.

Transition to raloxifene with and without low-dose estrogen therapy in postmenopausal women: effects on serum lipids and fibrinogen - a pilot study

Objective To compare the effects of transferring from low-dose transdermal estrogen to raloxifene (RLX), with a phase of alternate-day RLX therapy with or without low-dose transdermal estrogen, on serum lipids and fibrinogen in postmenopausal women previously administered estrogen plus progestogen therapy. Methods Sixty postmenopausal women (mean age 55 years) were randomized to one of two treatment groups: RLX + low-dose transdermal estrogen (RLX + E) or RLX + placebo. The study consisted of four 8-week phases: phase I (all subjects low-dose transdermal estrogen 25 mug/day), phase II (double-blind RLX 60 mg every 2nd day in combination with either low-dose transdermal estrogen or placebo), phase III (all subjects RLX 60 mg every 2nd day + placebo) and phase IV (all subjects RLX 60 mg/day + placebo). Results No significant differences existed between groups for baseline measurements prior to phase I. In phase I, for all subjects combined, total cholesterol and low-density lipoprotem cholesterol both showed a significant increase (median increase of 0.2 mmol/l, p = 0.008 and 0.4 mmol/l, p < 0.001, respectively), while triglycerides decreased significantly (median decrease of 0.2 mmol/l, p < 0.001). For the primary analysis (phase II to phase IV), the mean change from baseline observations showed no significant differences between the therapy groups for serum lipids, fibrinogen, vital signs or weight. In the comparison phase (phase II), changes in serum lipids, fibrinogen, vital signs and weight were not significantly different between groups. Conclusion Gradual conversion to RLX from low-dose transdermal estrogen, with a phase of alternate-day RLX therapy with or without low-dose transdermal estrogen, does not have any effect on the serum lipid profile or fibrinogen level.

Opening windows into the mind: mothers' preferences for mental state explanations and children's theory of mind

A new questionnaire, the Maternal Mental State Input Inventory (MMSII) was created to measure mothers' preferences for introducing and elaborating on mental states in conversation with their young children. In two studies, the questionnaire was given to mothers of young children, and the children's theory of mind (ToM) development was assessed with standard tasks. In both studies, the questionnaire exhibited good internal reliability, and significant correlations emerged between mothers' self-reported preferences for elaborated, explanatory talk about the mental states and children's theory of mind performance. Further, mothers' conversational preferences, as measured by the MMSII, were the best predictors of children's theory of mind development when relevant control variables were included in the analyses. These results converge with naturalistic observational research that has demonstrated links between mothers' conversational styles and their children's theory of mind. They go further in suggesting that mothers' tendencies toward elaborated, explanatory talk about a range of mental states is particularly beneficial to children's theory of mind development. (C) 2003 Elsevier Inc. All rights reserved.

Responsabilidade Criminal por Dinheiros Públicos, Branqueamento de Capitais/Lavagem de Dinheiro e Direitos Sociais

Em termos de dinheiros públicos, devemos ter em consideração a necessidade de ter que existir uma boa governança. É importante a participação. Também a transparência. E se os direitos e deveres sociais fundamentais estão interligados, não é menos verdade que é preciso a apresentação de boas contas à população. E aqui temos que falar também em plena responsabilidade pública. Num sentido lato, podemos falar num princípio geral de anticorrupção. O mau uso dos dinheiros públicos pode conduzir à responsabilidade de índole criminal. O crime de branqueamento/lavagem, um crime secundário, pode ter por origem ilícitos e/ou crimes que se relacionam com a utilização indevida de dinheiros públicos. A responsabilidade financeira e criminal pode aliás constituir um incremento na boa gestão dos dinheiros públicos. Deste modo – não tendo o direito penal finalidades de promoção ou de “combate”, mas ainda assim retributivos, preventivos gerais e especiais positivos e restaurativos -, podemos estar a caminhar para uma melhor concretização dos direitos, e dos deveres, que são garantidos do ponto de vista constitucional-constitucional. Afinal, todas as áreas do direito, são peças do mesmo jogo de xadrez. O Tribunal Constitucional em Portugal, o Supremo Tribunal Federal no Brasil, o Supremo Tribunal de Justiça em Portugal, o Superior Tribunal de Justiça no Brasil, os Tribunais de Contas em ambos os países. § In terms of public money, we should take into account the need to have to be good governance. It is important to participate. Also transparency. And if fundamental rights and social duties are interrelated, it is also true that we need to present good accounts to the population. And here we must also speak in full public accountability. In a broad sense, we can speak of a general principle of anti-corruption. The misuse of public funds can lead to criminal nature of responsibility. The crime of money laundering, a secondary crime, may have as illicit origin and / or crimes that relate to the misuse of public funds. The financial and criminal liability may in fact be an increase in the sound management of public funds. Thus - not having the criminal law purposes of promotion or "combat", but still remunerative, general and special preventive and restorative positive - we may be heading for a better realization of the rights, and duties, which are guaranteed the constitutional-constitutional point of view. After all, all areas of the law are parts of the same game of chess. The Constitutional Court in Portugal, the Supreme Court in Brazil, the Supreme Court in Portugal, the Superior Court of Justice in Brazil, the Audit Courts in both countries.

A HIPÓTESE INTEGRADORA DA GOVERNANÇA CORPORATIVA E DA RESPONSABILIDADE SOCIAL CORPORATIVA SOB O ENFOQUE DOS DIREITOS HUMANOS

A governança corporativa e a responsabilidade social corporativa são dois instrumentos que têm o caráter de atingir a excelência da organização empresarial. Por sua vez, os mesmos foram instrumentalizados como meio de proteção dos interesses dos agentes privados com vista à potencialização da sociedade empresarial, motivados pela desconfiança dos processos decisórios dos administradores societários. Posteriormente, evoluiram sob a forma de códigos de condutas, ditados pelos organismos de controle empresarial, sempre conservando o caráter voluntário de sua aceitação. Alguns objetivos sequer foram incluídos nos seus processos internos de excelência, como por exemplo os direitos humanos de determinados stakeholders. Esse ponto é o objeto principal desta investigação, que busca evidenciar a hipótese de integração da governança corporativa e da responsabilidade social corporativa sob o enfoque dos direitos humanos. § The Corporate governance and corporate social responsibility are two instruments that have the character to achieve excellence in business organization. On the other hand, they have been exploited as a way of protecting the interests of private agents for enhancement of corporate society, motivated by the distrust of the decision-making process of corporate managers. Later, it evolved in the form of codes of conduct, dictated by the bodies of corporate control, always preserving the voluntary nature of their acceptance. Some objectives were not even included in its internal process of excellence, such as the human rights of certain stakeholders. This point is the main object of this research, which seeks to demonstrate the possibility of integration of corporate governance and corporate social responsibility in the human rights perspective.

Anotação, numa perspectiva de Direito Penal Constitucional, de Criminologia e de Política Criminal, de alguns dos aspectos do Acórdão do Tribunal Constitucional (português) n.º 353/2012, de 5 de Julho de 2012 - o problema da legítima defesa de bens jurídicos individuais e bens jurídicos colectivos, bens jurídicos supra-individuais e/ou bens jurídicos comunitários no meio do Estado de Direito e do Estado Social

o Acórdão do Tribunal Constitucional português n.º 353/2012, de 5 de Julho de 2012, ao declarar a respectiva inconstitucionalidade com força obrigatória geral, colocou em evidência a existência de bens jurídicos individuais e bens jurídicos colectivos, bens jurídicos supra-individuais, bens jurídicos comunitários. Bens jurídicos estes que devem e têm que ser tutelados e protegidos. A legítima defesa pode existir quer em relação à agressão actual e ilícita de bens jurídicos individuais, quer em relação à agressão actual e ilícita de bens jurídicos colectivos, bens jurídicos supra-individuais e/ou bens jurídicos comunitários? Parte muito substancial e importante da Doutrina indica que sim. Mas, então, como reagir, no contexto da hipotética legítima defesa, face à eventual agressão actual e ilícita dos bens jurídicos tutelados, agora com valor reforçado, pelo próprio Tribunal Constitucional? E qual o papel do direito constitucional de resistência? Este artigo pretende fornecer um muito breve contributo para a solução das correspondentes questões. A questão dos Direitos Fundamentais, o Desenvolvimento e a modernidade. § the Sentence of the (Portuguese) Constitutional Court n. 353/2012 of July 5, 2012, declaring its generally binding unconstitutionality, has highlighted the existence of individual legal goods and collective legal goods, supra-individual legal goods, community legal goods. These legal goods, that should and must be defended and protected. Legitimate defense can be either relative to the current and illicit aggression to individual legal goods, whether in relation to the current and illicit aggression to collective legal goods, supra-individual legal goods or community legal goods? Very substantial and important part of the Doctrine would appear so. But then how to respond, in the context of hypothetical self-defense, in the face of possible current and illicit aggression of the protected legal goods, now with enhanced value, by the Constitutional Court? And what is the role of the constitutional right of resistance? This article is intended to provide a very brief contribution to the solution of the corresponding questions. The question of Fundamental Rights, Development and modernity.

Learning dependent sources using mixtures of Dirichlet: applications on hyperspectral unmixing

This paper is an elaboration of the DECA algorithm [1] to blindly unmix hyperspectral data. The underlying mixing model is linear, meaning that each pixel is a linear mixture of the endmembers signatures weighted by the correspondent abundance fractions. The proposed method, as DECA, is tailored to highly mixed mixtures in which the geometric based approaches fail to identify the simplex of minimum volume enclosing the observed spectral vectors. We resort then to a statitistical framework, where the abundance fractions are modeled as mixtures of Dirichlet densities, thus enforcing the constraints on abundance fractions imposed by the acquisition process, namely non-negativity and constant sum. With respect to DECA, we introduce two improvements: 1) the number of Dirichlet modes are inferred based on the minimum description length (MDL) principle; 2) The generalized expectation maximization (GEM) algorithm we adopt to infer the model parameters is improved by using alternating minimization and augmented Lagrangian methods to compute the mixing matrix. The effectiveness of the proposed algorithm is illustrated with simulated and read data.

Immunogenicity of WHO-17D and Brazilian 17DD yellow fever vaccines: a randomized trial

OBJECTIVE: To compare the immunogenicity of three yellow fever vaccines from WHO-17D and Brazilian 17DD substrains (different seed-lots). METHODS: An equivalence trial was carried out involving 1,087 adults in Rio de Janeiro. Vaccines produced by Bio-Manguinhos, Fiocruz (Rio de Janeiro, Brazil) were administered following standardized procedures adapted to allow blocked randomized allocation of participants to coded vaccine types (double-blind). Neutralizing yellow fever antibody titters were compared in pre- and post-immunization serum samples. Equivalence was defined as a difference of no more than five percentage points in seroconversion rates, and ratio between Geometric Mean Titters (GMT) higher than 0.67. RESULTS: Seroconversion rates were 98% or higher among subjects previously seronegative, and 90% or more of the total cohort of vaccinees, including those previously seropositive. Differences in seroconversion ranged from -0.05% to -3.02%. The intensity of the immune response was also very similar across vaccines: 14.5 to 18.6 IU/mL. GMT ratios ranged from 0.78 to 0.93. Taking the placebo group into account, the vaccines explained 93% of seroconversion. Viremia was detected in 2.7% of vaccinated subjects from Day 3 to Day 7. CONCLUSIONS: The equivalent immunogenicity of yellow fever vaccines from the 17D and 17DD substrains was demonstrated for the first time in placebo-controlled double-blind randomized trial. The study completed the clinical validation process of a new vaccine seed-lot, provided evidence for use of alternative attenuated virus substrains in vaccine production for a major manufacturer, and for the utilization of the 17DD vaccine in other countries.

Aplicação da abordagem socioeconómica na Empresa X: corrigir disfunções e potenciar resultados – estudo de caso

Mestrado em Contabilidade

Atas do VI Encontro do CIED – I Encontro Internacional em estudos educacionais. avaliação: desafios e riscos

Esta publicação contém as comunicações apresentadas no VI Encontro do CIED – I Encontro Internacional em Estudos Educacionais. Avaliação: Desafios e Riscos, nos dias 15 e 16 de novembro de 2013, na Escola Superior de Educação de Lisboa, Instituto Politécnico de Lisboa, organizado pelo CIED, com o apoio da Escola Superior de Educação de Lisboa.

Short- and medium-term effects of manual therapy on cervical active range of motion and pressure pain sensitivity in latent myofascial pain of the upper trapezius muscle: a randomized controlled trial

Objective: The purpose of this study was to investigate effects of different manual techniques on cervical ranges of 17 motion and pressure pain sensitivity in subjects with latent trigger point of the upper trapezius muscle. 18 Methods: One hundred seventeen volunteers, with a unilateral latent trigger point on upper trapezius due to computer 19 work, were randomly divided into 5 groups: ischemic compression (IC) group (n = 24); passive stretching group (n = 20 23); muscle energy technique group (n = 23); and 2 control groups, wait-and-see group (n = 25) and placebo group 21 (n = 22). Cervical spine range of movement was measured using a cervical range of motion instrument as well as 22 pressure pain sensitivity by means of an algometer and a visual analog scale. Outcomes were assessed pretreatment, 23 immediately, and 24 hours after the intervention and 1 week later by a blind researcher. A 4 × 5 mixed repeated- 24 measures analysis of variance was used to examine the effects of the intervention and Cohen d coefficient was used. 25 Results: A group-by-time interaction was detected in all variables (P b .01), except contralateral rotation. The 26 immediate effect sizes of the contralateral flexion, ipsilateral rotation, and pressure pain threshold were large for 3 27 experimental groups. Nevertheless, after 24 hours and 1 week, only IC group maintained the effect size. 28 Conclusions: Manual techniques on upper trapezius with latent trigger point seemed to improve the cervical range of 29 motion and the pressure pain sensitivity. These effects persist after 1 week in the IC group. (J Manipulative Physiol 301 Ther 2013;xx:1-10)