Necessidades em cuidados paliativos do doente pós-AVC

Relatório de Prática Clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos, realizada sob a orientação científica do Professora Doutora Ana Paula Gonçalves Antunes Sapeta, do Instituto Politécnico de Castelo Branco.

The impact of online promotional efforts on customer acquisitiom and retention at continente.pt

Continente Online (COL) is the market leader of online grocery retailing in Portugal. Aiming at sustaining this position, it has been focusing its promotional efforts in acquiring and retaining customers. This report intakes an extensive study on the impact of COL’s exclusive promotional efforts (free delivery offers and ten percent discounts on loyalty card) on customer acquisition and retention, as well as, a cost analysis on these offers. Two econometric models were developed and the results were interesting. It was concluded that free delivery offers have a significant impact both in terms of customer acquisition and retention, having also a lower cost in comparison with ten percent on loyalty card discounts.

Competition policy costs to firms

The existence of competition policy forces companies to adjust their behaviour. This is also costly. Using a database from a company on contracts, I will try to estimate if a specific competition policy disposition, supply contracts cannot be longer than 60 months, has costs for the coffee suppliers operating in the Portuguese “on-trade” coffee market. The estimation method used in this paper will be OLS. The results suggest that limiting the duration of exclusivity contracts to 60 months can be harmful to the coffee suppliers and it can even seriously affect the market functioning. Key

Consumo de álcool nas mães que amamentam durante o 1º ano de vida da criança, prevalência e fatores associados, em Vila Fanca de Xira, em 2014

RESUMO - Introdução: O consumo de álcool durante o aleitamento materno é um tema que tem vindo a ganhar relevo nos últimos anos. Contrariamente ao consumo de álcool durante a gravidez, em que já se conhecem bem as consequências sobre o feto, sobre os efeitos do consumo de álcool durante a amamentação ainda pouco se sabe. Este estudo visa, assim, caracterizar o consumo de álcool e fatores associados nas mães que amamentam, ou amamentaram, durante o 1º ano de vida da criança no concelho de Vila Franca de Xira em 2014. Metodologia: Foi realizado um estudo transversal, com a aplicação de um questionário de auto-preenchimento, a uma amostra estratificada e com alocação proporcional por Unidade Funcional, de mães que estiveram nas consultas de saúde infantil das unidades de saúde do concelho, entre março e maio de 2014. Resultados: A idade mediana das mães foi 31 anos e das crianças foi 3 meses. O tempo total em aleitamento teve uma mediana de 2 meses e somente 16,3% amamentaram mais de 5 meses. A prevalência do consumo de álcool durante a amamentação foi 7,9% e na gestação foi 8,1%. Os fatores que se associaram, com significância estatística, ao consumo de álcool na amamentação foram a maior idade da mãe, os conhecimentos que esta possuía e o consumo anterior de álcool na gestação. Os hábitos tabágicos durante a amamentação tiveram uma prevalência de 13,4% e o consumo de substâncias ilícitas de 0,6%. Conclusões: A prevalência do consumo de álcool durante a amamentação, a nível local, mantém-se semelhante à da gestação, sendo muito inferior à encontrada em outros estudos de outros países. O tempo total em amamentação é baixo considerando as recomendações nacionais e internacionais.

As Comissões Parlamentares de Inquérito no Portugal democrático, 1976-2015

As transformações operadas no mundo contemporâneo, em especial no que respeita às estruturas do poder, à sua maior autonomização e diferenciação, tiveram particulares reflexos ao nível dos Parlamentos e das funções que prosseguem. Desde a sua origem, no passado século XIII, à atualidade, grandes acontecimentos, clivagens e factos históricos estão presentes na sua linha evolutiva. A democratização do regime parlamentar e a legitimidade outorgada através de eleições democráticas e concorrenciais são um marco ímpar na sua história. A complexidade das sociedades hodiernas catapultou o Poder Executivo em detrimento do Parlamento, enquanto órgão legislativo por excelência. Tal circunstancialismo levou, não ao proclamado declínio dos Parlamentos, mas a reformas estruturantes. Outras e mais importantes funções seriam prosseguidas. Se as iniciativas legislativas e a definição das políticas públicas passaram a ser quase um exclusivo do Governo, havia que desenvolver e ampliar, por parte dos Parlamentos, os instrumentos de controlo, fiscalização e escrutínio da ação governativa. Entre os clássicos instrumentos de controlo avulta o Inquérito Parlamentar, materializado em Comissões Parlamentares de Inquérito, dotadas de poderes especiais para recolha de informação e para investigação. No seu percurso parlamentar, também as Comissões de Inquérito foram sendo alvo de constantes aperfeiçoamentos, de ordem constitucional, legal e regimental. A excessiva partidarização da atividade parlamentar de outrora e sobretudo a confusão entre o governo e o partido que o sustentava a nível parlamentar, o confronto desequilibrado de meios entre as maiorias e as minorias, levaram a um reposicionamento do inquérito parlamentar enquanto garante do direito das minorias. Não sendo expectável que as grandes iniciativas de controlo sejam tomadas pelo partido maioritário, cabe à oposição esse papel. Em Portugal, diminuta era a tradição do instituto do inquérito parlamentar, razão porque foi efémera e sem resultado a sua utilização no tempo da monarquia constitucional. O regime democrático, abraçado com o 25 de abril de 1974, relançou o órgão de soberania Parlamento e estabeleceu prioridades. Até ao amadurecimento da democracia viveram-se tempos mais conturbados mas de grande aprendizagem. O inquérito Parlamentar, a partir da revisão constitucional de 1982, passou conceptualmente a integrar um dos meios mais relevantes da fiscalização política. É, pois, o levantamento exaustivo e a análise das Comissões Parlamentares de Inquérito no Portugal democrático, período de 1976-2015, o objetivo a que nos propomos neste estudo.

BCR and TLR signalling pathways are recurrently targeted by genetic changes in splenic marginal zone lymphomas.

The genetics and pathogenesis of splenic marginal zone lymphoma are poorly understood. The lymphoma lacks chromosome translocation, and ~30% of cases are featured by 7q deletion, but the gene targeted by the deletion is unknown. A recent study showed inactivation of A20, a 'global' NF-kB negative regulator, in 1 of 12 splenic marginal zone lymphoma. To investigate further whether deregulation of the NF-kB pathway plays a role in the pathogenesis of splenic marginal zone lymphoma, we screened several NF-kB regulators for genetic changes by PCR and sequencing. Somatic mutations were found in A20 (6/46=13%), MYD88 (6/46=13%), CARD11 (3/34=8.8%), but not in CD79A, CD79B and ABIN1. Interestingly, these genetic changes are largely mutually exclusive from each other and MYD88 mutation was also mutually exclusive from 7q deletion. These results strongly suggest that deregulation of the TLR (toll like receptor) and BCR (B-cell receptor) signalling pathway may play an important role in the pathogenesis of splenic marginal zone lymphoma.

Coat color dilution in mice because of inactivation of the melanoma antigen MART-1.

Melanoma antigen recognized by T cells 1 (MART-1) is a melanoma-specific antigen, which has been thoroughly studied in the context of immunotherapy against malignant melanoma and which is found only in the pigment cell lineage. However, its exact function and involvement in pigmentation is not clearly understood. Melanoma antigen recognized by T cells 1 has been shown to interact with the melanosomal proteins Pmel17 and OA1. To understand the function of MART-1 in pigmentation, we developed a new knockout mouse model. Mice deficient in MART-1 are viable, but loss of MART-1 leads to a coat color phenotype, with a reduction in total melanin content of the skin and hair. Lack of MART-1 did not affect localization of melanocyte-specific proteins nor maturation of Pmel17. Melanosomes of hair follicle melanocytes in MART-1 knockout mice displayed morphological abnormalities, which were exclusive to stage III and IV melanosomes. In conclusion, our results suggest that MART-1 is a pigmentation gene that is required for melanosome biogenesis and/or maintenance.

Variabilidad espacial de la pesquería de Dosidicus gigas (d’Orbigny, 1835) calamar gigante del 2004 al 2012

Se efectuó un análisis de la distribución espacial de operaciones de pesca de la flota calamarera industrial dentro y fuera de la zona económica exclusiva peruana (ZEE) con relación a la temperatura superficial de mar (TSM) y concentración de clorofila-a (Cl-a) para el periodo 2004-2012. La data de operaciones de pesca se dividió en tres periodos en función a distancia a la costa considerando regulaciones de pesca, de enero 2004 a octubre 2010, de noviembre 2010 a diciembre 2011 y 2012. Durante el primer periodo, se identificaron dos patrones mensuales de distribución espacial, de enero a julio fue a lo largo del litoral desde Paita (5°S) hasta San Juan de Marcona (15°22’S) y de agosto a diciembre entre Chimbote y Paita. En el segundo periodo, las operaciones de pesca formaron pequeñas concentraciones y puntos de pesca dispersas debido a la restricción de pesca dentro de las 80 millas náuticas desde noviembre del 2010. Durante el 2012 la flota se localizó fuera de la ZEE. Las mayores concentraciones de la flota se ubicaron entre 30 a 90 millas náuticas de la costa. Mayores concentraciones de pesca se localizaron en Paita-Chimbote (5°-9°S) y Callao- San Juan de Marcona (12°03’-15°22’S). Las faenas de pesca se realizaron en un rango amplio de TSM entre 14,1 y 26,8 °C, con mayor incidencia en temperaturas entre 18,4 a 22 °C, con tendencia a localizarse en áreas de mayor temperatura durante los últimos años. Respecto a la clorofila-a, la flota faenó entre concentraciones de clorofila-a de 0 a 9,5 mg/m3 dentro de la ZEE, y entre 0,2 y 0,5 mg/m3 fuera de la ZEE. Se observó un patrón de distribución de flota, asociado a las anomalías de temperatura superficial de mar del área El Niño 1+2, a la distribución latitudinal y una variabilidad cíclica mensual de la TSM.

Social trust : a public good?

Combining theories on social trust and social capital with sociopsychological approaches and applying contextual analyses to Swiss and European survey data, this thesis examines under what circumstances generalised trust, often understood as public good, may not benefit everyone, but instead amplify inequality. The empirical investigation focuses on the Swiss context, but considers different scales of analysis. Two broader questions are addressed. First, might generalised trust imply more or less narrow visions of community and solidarity in different contexts? Applying nonlinear principal component analysis to aggregate indicators, Study 1 explores inclusive and exclusive types of social capital in Europe, measured as regional configurations of generalised trust, civic participation and attitudes towards diversity. Study 2 employs multilevel models to examine how generalised trust, as an individual predisposition and an aggregate climate at the level of Swiss cantons, is linked to equality- directed collective action intention versus radical right support. Second, might high-trust climates impact negatively on disadvantaged members of society, precisely because they reflect a normative discourse of social harmony that impedes recognition of inequality? Study 3 compares how climates of generalised trust at the level of Swiss micro-regions and subjective perceptions of neighbourhood cohesion moderate the negative relationship between socio-economic disadvantage and mental health. Overall, demonstrating beneficial, as well as counterintuitive effects of social trust, this thesis proposes a critical and contextualised approach to the sources and dynamics of social cohesion in democratic societies. -- Cette thèse combine des théories sur le capital social et la confiance sociale avec des approches psychosociales et s'appuie sur des analyses contextuelles de données d'enquêtes suisses et européennes, afin d'étudier dans quelles circonstances la confiance généralisée, souvent présentée comme un bien public, pourrait ne pas bénéficier à tout le monde, mais amplifier les inégalités. Les études empiriques, centrées sur le contexte suisse, intègrent différentes échelles d'analyse et investiguent deux questions principales. Premièrement, la confiance généralisée implique-t-elle des visions plus ou moins restrictives de la communauté et de la solidarité selon le contexte? Dans l'étude 1, une analyse à composantes principales non-linéaire sur des indicateurs agrégés permet d'explorer des types de capital social inclusif et exclusif en Europe, mesurés par des configurations régionales de confiance généralisée, de participation civique, et d'attitudes envers la diversité. L'étude 2 utilise des modèles multiniveaux afin d'analyser comment la confiance généralisée, en tant que prédisposition individuelle et climat agrégé au niveau des cantons suisses, est associée à l'intention de participer à des actions collectives en faveur de l'égalité ou, au contraire, à l'intention de voter pour la droite radicale. Deuxièmement, des climats de haute confiance peuvent-ils avoir un impact négatif sur des membres désavantagés de la société, précisément parce qu'ils reflètent un discours normatif d'harmonie sociale qui empêche la reconnaissance des inégalités? L'étude 3 analyse comment des climats de confiance au niveau des micro-régions suisses et la perception subjective de faire partie d'un environnement cohésif modèrent la relation négative entre le désavantage socio-économique et la santé mentale. En démontrant des effets bénéfiques mais aussi contre-intuitifs de la confiance sociale, cette thèse propose une approche critique et contextualisée des sources et dynamiques de la cohésion sociale dans les sociétés démocratiques.

Recueil de lettres et de pièces originales, et de copies de pièces indiquées comme telles dans le dépouillement qui suit.

Contient : 1 Lettre du roi « CHARLES [IX]... à monseigneur Du Bouchaige,... Escript à Longpont, le IXme jour de may 1561 » ; 2 Arrêt du conseil pour la justification de Louis de Bourbon, prince de Condé. « Du huictiesme jour de mars, l'an mil cinq cens soixante et un ». Copie ; 3 Lettre de « LOYS DE BOURBON [prince DE CONDE]... à... monseigneur le prince de Protez,... Escript à St Germain en Laye... may 1563 » ; 4 Lettre de « FRANÇOIS DE MONTMORENCY » à Louis de Bourbon, duc de Montpensier. « De Paris, ce quinzeme jour de janvier 1564 ». Copie ; 5 Lettre de « LOUIS DE BOURBON, duc DE MONTPENSIER », à François de Montmorency. « D'Argenton, ce IIIIe jour de fevrier 1564 » ; 6 Lettre de « HENRY [DE FRANCE, duc D'ANJOU]... à monseigneur le conte Du Bouchaige,... Escript au camp de Chinon, le XIIIme jour de janvier 1569 » ; 7 Lettre du roi « CHARLES [IX]... à monseigneur le conte Du Bouchaige,... Escript à Chaalons, le XXVe jour de janvier 1569 » ; 8 Lettre d'« ANTOYNE [DE BOURBON, roi de Navarre]... à... madame la vidame d'Amyens... Escript à St Germain en Laye, le VIIe jour de decembre 1561 » ; 9 Lettre de « JEHANNE [D'ALBRET, reine de Navarre]... à ma cousine » ; 10 Lettre de « LOYS DE BOURBON,... à monseigneur [le] conte Du Bouchaige,... De Champigny, ce XXIIIme jour de juing 1568 » ; 11 Lettre de GASPARD DE COLIGNY, amiral DE « CHASTILLON,... à monsieur... Du Bouchage,... De La Rochelle ce XVIIIe jour d'avril 1571 » ; 12 Lettre d'« E[MMANUEL] PHILIBERT [duc DE SAVOIE]... De Thurin, ce XVme jour d'apvril 1576 » ; 13 Lettre de « CHASTILLON,... à monsieur... Du Bouchage,... De Chastillon, ce XXXe jour d'octobre 1571 » ; 14 Lettre de Mme « J. D'ANTREMONT,... à monsieur le conte Du Bouchaige,... A Chastillon, ce dernier octobre 1571 » ; 15 Lettre de Mr « DE PRYE,... à monseigneur le conte Du Bouchaige,... De Monpoupon, ce vendredi matin » ; 16 Lettre de « NANÇAY,... à monsieur... le conte Du Bouchage,... De Bloys, ce XXIXme jour de septambre » ; 17 Lettre de « NANÇAY,... à monsieur le conte Du Bouchage,... Du camp de Nieul devant La Rochelle, le XXXe mars 1573 » ; 18 Lettre d'ANNE DE « MONTMORENCY,... à... madame Du Bouchaige,... De St Germain en Laye, ce XXIXe jour de jung » ; 19 Lettre de « NANÇAY,... à monsieur... le conte Du Bouchaige,... De Blois, ce Ve may 1572 » ; 20 Lettre d'ANNE DE « MONTMORENCY,... à... madame la vidasme d'Amyens... De Fontainebleau, ce XVIIIe fevrier 1560 » ; 21 Lettre d'« ANTHOINETTE DE BOURBON,... [duchesse DE GUISE]... à... madame la vidasme d'Amyens... De Joinville, ce Xme jour de juillet 1563 » ; 22 Lettre d'« ANTHOINETTE [DE BOURBON, duchesse DE GUISE]... à... madame la vidasme d'Amiens... De Joinville, ce XVme jour de febvrier 1560 » ; 23 Commission du roi « CHARLES [IX]... à noz amez et feaux Mes Jehan Chastellier, seigneur de Millieu,... Robert de Montdoucet,... Françoys Pain », sur le fait des finances. « Donné à Amboise, le XVIIe jour de febvrier, l'an de grace mil cinq cens soixante et douze ». Copie ; 24 Lettres patentes du roi « CHARLES » IX, rétablissant dans la ville de Metz la profession exclusive du culte catholique. « Donné à Metz, le sixiesme jour d'avril, l'an de grace mil cinq cens soixante et neuf » ; 25 Lettre de « LOYSE DE PIENES,... à madame la vidame d'Amyens, douairiere... De Joinville, ce IIIe jour de may 1562 » ; 26 Lettre d'ANNE DE « MONTMORENGY,... à mon nepveu d'Authon,... D'Escouen, ce XVIIIe jour d'aoust 1561 » ; 27 Lettre de « NANÇAY,... à monsieur... le conte Du Bouchage,... De Victry, ce Ve novembre 1573 » ; 28 « Traicté de l'alliance des Suisses par le roy Charles neufviesme... Faict et passé en la... ville de Fribourg... decembre XV.C. soixante et quatre ». Copie ; 29 « Ordonnances des cent suisses de la garde du roy... translatté par GUILLEAUME TOUGUINER, dit FREULIOF, truchement du roy et protenseigne des cent suisses... du langage d'allemant en françois. Faict le seiziesme jour de janvier 1567 » ; suivies d'une note de « Guilleaume Touguiner » relative aux divers grades et fonctions occupés par lui. Copie ; 30 Lettre de « CLAUDE DE LORRAINE [duc D'AUMALE]... à monseigneur de Nancé, cappitaine des gardes du corps du roy... De Nancy, ce XVIme jour d'octobre 1571 » ; 31 Lettre de « LOYS DE BOURBON [duc DE MONTPENSIER]... à... monseigneur le comte Du Bouchage,... De Champigny, ce XXXme et penultime jour de decembre 1577 » ; 32 Lettre de « JOYEUSE,... à monseigneur... le conte Du Bouchaige,... A Thoulouse, le XVII febvrier » ; 33 Lettre de « JOYEUSE,... à monsieur... le conte Du Bouchaige,... Au camp de Montbron, se XIIII may » ; 34 « Pasqun des troubles advenuz au royaume de France en l'année mil cinq cens soixante sept jusques en l'année mil cinq cens soixante huyct » ; 35 Brevet de capitaine gouverneur du Mont-St-Michel, accordé par le roi Henri III à Anne de Joyeuse, sur la requête du titulaire, le comte Du Bouchage. 27 février 1579. Copie ; 36 « Coppie de lectre de monsieur le duc DE MONTPENCIER,... LOYS DE BOURBON,... à monseigneur de St Moris,... De Mortaing, ce XXVIIe jour de jung 1573 » ; 37 « Coppie de lectre du roy... CHARLES [IX]... à monsieur de Sainct Moris,... cappitaine du Mont Sainct Michel... Escript à Monceaulx, le XVIe jour de jung 1573 » ; 38 « Coppie de lectre de la royne mere... CATERINE [DE MEDICIS]... à monseigneur de St Moris,... Escript à Monceaulx, le XIIIe jour de jung 1573 » ; 39 « Coppie de lectre de monsieur DE MATIGNON,... à monseigneur... de Sainct Moris,... A Thorigny, le VIIe d'aoust 1573 » ; 40 « Nouvelles » du « camp de Dompfront... Ce lundi matin 24 may 1574 ». Copie

Diversity in the fitness industry : a cross-case comparison /

This cross-case study explored the extent to which two fitness facilities were accommodating diversity with respect to age, ethnicity, gender, social class, sex-role socialization, and persons with a disability among both members and staflf. The sites were purposely chosen in a large city and a smaller city in order to provide as representative an example as possible of health clubs within a small sample population. The interview participants were selected by a combination of stratified, typical case, and snowball sampling strategies. . , .. , The intent of the exploration was a two-fold examination of diversity issues within both the membership and the staff of the organization. Data were collected and analysis was done using a triangulation method involving personal interviews, observations, and facility documentation. The results ofthe study showed that the members and staff at each facility were rather homogeneous in ethnicity, age, social class, physical ability, and physical appearance. From a membership standpoint, the environment of the sites presented the impression of being affordable only to the middle- and upper-middle classes, unwelcoming to the older, less fit, or overweight participant, economically exclusive for youth, and nonaccommodating for people with a disability. With respect to staff, the findings indicated that the fitness facilities purported to be team-oriented in theory, but were hierarchical in practice, with the major decision making being made by the male executives. The paper concludes with the recommendation that students must be given a practical toolkit for dealing with these issues in their postsecondary courses.

Opening a can of worms : perceptions and practices of teachers in Newfoundland and Labrador incorporating the role of a therapist

Educational trends of inclusion and collaboration have led to changing roles of teachers, including an emphasis on personal support. To provide for social, emotional, and behavioural needs, teachers may adopt a therapeutic role. Many models for such support are proposed, with most models including the importance of student-teacher relationships, a focus on social, emotional, and behavioural development, and direct instruction of related skills. This study includes 20 interview participants. In addition, 4 of the 20 interview participants also took part in a case study. It examines whether participants adopt a therapeutic role, their beliefs about student-teacher relationships, whether they provide interventions in personal issues, and instructed social, emotional, and behaviour skills. Findings show that teachers adopt an academic role as well as a therapeutic role, believe student-teacher relationships are important, are approached about personal issues, and instruct social, emotional, and behavioural skills. Talking and listening are commonly used to provide support, typically exclusive of formal curricular goals. The challenges in providing front-line support issues that may be shared within an established student-teacher relationship are considered. Support in turn for teachers who choose to provide support for personal issues in the classroom within a therapeutic role are suggested, including recommendations for support and referral related to specific social, emotional, or behavioural scenarios that may arise in the school community.

Examining the potential application of childhood stature in assessing adolescent overweight and obesity

Background: Increasing Overweight and Obesity (OwOb) prevalence in pediatric populations is becoming a public health concern in many countries. The purpose of this study was to determine if childhood stature components, particularly the Leg Length Index (LLI = [height - sitting height]! height), were useful in assessing risk of OwOb in adolescence. Methods: Data was from a longitudinal study conducted in south Ontario since 2004. Approximately 2360 students had body composition measurements including sitting height and standing height at baseline. Among them, 1167 children (573 girls, 594 boys) who had weight and height measured at the 5 th year follow-up, were included in this analysis. OwOb was defined using age and sex specific BMI (kg!m 2 ) cut-off points corresponding to adults' BMI ~ 25. Results: Overall, 34% (n=298) of adolescents were considered as OwOb. The results from logistic regression analysis indicated that with 1 unit increase in LLI the odds of OwOb decreased 24% (Odds Ratio, [95% Confidence Interval], 0.76, [0.66-0.87]) after adjusted for age, sex and baseline waist circumference. Further adjusting for birth weight, birth order, breastfeeding, child's physical activity, maternal smoking, education, mother's age at birth and mother's BMI, did not change the relationship. Our results also indicated that mother's smoking status is associated with LLI. Discussion: Although LLI measured at childhood in this study is related to OwOb risk in adolescents, the underlying mechanism is unclear and further study is needed.

Letter to S.D. Woodruff from William Colburn with the letterhead “Office of Detroit Bridge and Iron Works”

Letter to S.D. Woodruff from William Colburn with the letterhead “Office of Detroit Bridge and Iron Works” regarding stating that he closed up the business with Dewey’s. He states that “we” now have “warranty deeds” from them for exclusive rights for all time for hunting, shooting and trapping, Mar. 20, 1884.

Familial deletion 18p syndrome: case report

Affiliation: CHU Ste-Justine, Université de Montréal