994 resultados para Pressão intra-abdominal


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We study the earnings structure and the equilibrium assignment of workers when workers exert intra-firm spillovers on each other.We allow for arbitrary spillovers provided output depends on some aggregate index of workers' skill. Despite the possibility of increasing returns to skills, equilibrium typically exists. We show that equilibrium will typically be segregated; that the skill space can be partitioned into a set of segments and any firm hires from only one segment. Next, we apply the model to analyze the effect of information technology on segmentation and the distribution of income. There are two types of human capital, productivity and creativity, i.e. the ability to produce ideas that may be duplicated over a network. Under plausible assumptions, inequality rises and then falls when network size increases, and the poorest workers cannot lose. We also analyze the impact of an improvement in worker quality and of an increased international mobility of ideas.

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Aim: Gas6 is known to be elevated in sepsis, correlating with the severity of infection and¦organ failure. We aimed to investigate the performance of Gas6 plasma levels at¦admission to predict the risk of mortality in a cohort of septic patients.¦Methods: We used prospectively collected data and plasma samples from the "Sepsis¦Cohorte Romande". Gas6 level was measured by ELISA at admission and expressed in¦percentage relative to its level in a pool of normal plasma.¦Results: Non-survivors (n=21) presented higher Gas6 levels than survivors (n=73) (median¦258% vs 164%, IQR 194 and 117 respectively) (p=0.0027). Gas6 correlated positively with¦different cytokines and was the best mortality predictor, as shown by the ROC curves area.¦In patients with septic shock (n=66), using 249% as a cut-off value, Gas6 measurement¦had a specificity of 67% and a sensitivity of 81% for predicting mortality. ROC curve area¦was 0.75. Positive and negative predictive values were 57% and 87%, respectively.¦Conclusion: Thus, Gas6 plasma level at admission might be a useful tool to predict¦mortality in patients with septic shock. Although Gas6 hold promise as an early sepsis¦marker, its precise implication in sepsis remains to be elucidated. Our observation should¦be further investigated in larger prospective clinical trials.

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The aim was to propose a strategy for finding reasonable compromises between image noise and dose as a function of patient weight. Weighted CT dose index (CTDI(w)) was measured on a multidetector-row CT unit using CTDI test objects of 16, 24 and 32 cm in diameter at 80, 100, 120 and 140 kV. These test objects were then scanned in helical mode using a wide range of tube currents and voltages with a reconstructed slice thickness of 5 mm. For each set of acquisition parameter image noise was measured and the Rose model observer was used to test two strategies for proposing a reasonable compromise between dose and low-contrast detection performance: (1) the use of a unique noise level for all test object diameters, and (2) the use of a unique dose efficacy level defined as the noise reduction per unit dose. Published data were used to define four weight classes and an acquisition protocol was proposed for each class. The protocols have been applied in clinical routine for more than one year. CTDI(vol) values of 6.7, 9.4, 15.9 and 24.5 mGy were proposed for the following weight classes: 2.5-5, 5-15, 15-30 and 30-50 kg with image noise levels in the range of 10-15 HU. The proposed method allows patient dose and image noise to be controlled in such a way that dose reduction does not impair the detection of low-contrast lesions. The proposed values correspond to high- quality images and can be reduced if only high-contrast organs are assessed.

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A presente investigação tem como objectivo analisar a evolução do comércio intra-sectorial nas relações bilaterais entre Portugal e os países da União Europeia durante o período de 1995-2008 para os sectores: 31 e 34 e o impacto sobre das principais variáveis explicativas: diferença do rendimento per capita, diferença das dotações relativas, valor mínimo do rendimento per capita, valor máximo do rendimento per capita, BORDER (adjacência/fronteira), distância geográfica e dimensão do mercado (das economias) sobre o comércio intra-sectorial. A intensidade e a contribuição do comércio intra-sectorial é medida em termos absolutos e relativos através do índice proposto por Grubel e Lloyd (1975); a desagregação do comércio intra-sectorial horizontal e vertical é efectuada utilizando o critério de Abd-EL-Rahman (1991) e Grenaway et al. (1994) aplicado ao índice de Grubel e Lloyd. Os resultados obtidos mostraram que o comércio intra-sectorial vertical representa maior peso no total do comércio intra-sectorial nas relações bilaterais entre Portugal e a União Europeia, para ambos os sectores tanto em termos absolutos como em termos relativos. Em termos dos resultados econométricos verificou-se que a variável, proxy diferença do consumo eléctrico per capita utilizada para medir as dotações relativas possui um efeito negativo sobre o comércio intra-sectorial. As variáveis dimensão do mercado e valor mínimo do rendimento per capita apresentam um impacto positivo sobre o comércio intra-sectorial.

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Purpose: To determine whether the need for retreatment after an initial phase of 3 monthly intravitreal injections of ranibizumab shows an intra-individual regular rhythm and to what degree it varies between different patients. Methods: Prospective study with 42 patients with exudative AMD, treatment naïve. Loading dose of 3 monthly doses of ranibizumab (0,5 mg), followed by a 12 months pro re nata (PRN) regimen according to early exudative signs on HD-OCT Cirrus, Zeiss. The follow-up visits were intensified (week 4, 5, 6, 7, 8, 10, 12, 14, 16, 20, etc after each injection) in order to detect recurrences early, and injection followed within 3 days in cases of subretinal fluid, cysts, or central thickness increase of>50microns. Intervals were calculated between injections for the 12 month follow-up with PRN treatment. Variability was expressed as standard deviation (SD). Results: Visual acuity (VA) improved from a mean ETDRS score of 61.6 (SD 10.8) at baseline to 68.0 (SD 10.2) at month 3 and to 74.7(SD 9.0) at month 12. The 15 patients who have already completed the study showed maintenance of the VA improvement. Central foveal thickness improved from a mean value of 366 microns (baseline) to 253 microns (month 3), well maintained thereafter. Mean number of injections was 8.8 (SD 3.5,range 0-12) per 12 months of follow-up (after 3 doses), with mean individual treatment-recurrence (TR) intervals ranging from 28->365 days (mean 58). Intraindividual variability of TR intervals (SD) was 7.1 days as a mean value (range 1.7¡V22.6). It ranged within 20% of the mean intra-individual interval for 30 (91%) and within 15% for 21 patients (64%). The first interval was within 1 week of the mean intra-individual interval in 64% and within 2 weeks in 89% of patients. Conclusions: The majority of AMD patients showed a relatively stable rhythm for PRN injections of ranibizumab after initial loading phase, associated with excellent functional/anatomical results. The initial interval last loading dose-first recurrence may have a predictive value for further need of treatment, potentially facilitating follow-up and patient care.

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A prevenção das úlceras de pressão constitui um desafio para todos os profissionais de saúde em especial, a equipa de enfermagem que está mais directamente ligada aos cuidados de longa duração e que também estabelece uma ligação à uma boa qualidade de saúde. Diante desta realidade, verifica-se uma grande necessidade de adaptar e melhorar certas medidas preventivas com o propósito de diminuir o sofrimento dos utentes que muitas vezes tem problemas na mobilidade e por isso permanecem muito tempo na cama, desenvolvendo assim úlceras de pressão. E para que isto não aconteça é preciso conhecer toda a abordagem das úlceras de pressão, nomeadamente os grandes factores de riscos que estão na origem deste problema, para uma melhor tomada de decisão na área preventiva. A partir desta reflexão, surgiu este presente trabalho com o objectivo principal de conhecer as intervenções de enfermagem que visam a prevenção de úlceras de pressão nos utentes acamados, realizados no Hospital Batista Sousa, particularmente nos serviços de cirurgia e de medicina. Para dar resposta ao principal objectivo optou-se primeiramente por uma revisão bibliográfica e exploratória dos principais conceitos para uma melhor compreensão do tema em estudo, seguida do método de pesquisa qualitativa que permitiu compreender bem o fenómeno na sua dimensão mais ampla. E, para a recolha das informações, aplicou-se a técnica de entrevista semi-estruturada à 6 enfermeiros dos serviços de cirurgia e de medicina do Hospital Batista Sousa, respeitando assim os princípios éticos conhecidas. Deste estudo realizado, pode-se constatar que os enfermeiros dos serviços anteriormente referidos, adoptam várias estratégias para prevenirem as úlceras de pressão, de acordo com os recursos e conhecimentos disponíveis. Entretanto nota-se uma grande necessidade de aperfeiçoar ainda mais as práticas preventivas experimentando novos recursos utilizados na prevenção das úlceras de pressão, investir mais nos meios tanto materiais como humanos e também no melhoramento do trabalho em equipa, para tomar certas decisões dirigidas aos utentes com uma certa dependência.

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The aims of this thesis were to better characterize HIV-1 diversity in Portugal, Angola, Mozambique and Cape Verde and to investigate the origin and epidemiological history of HIV-1 in these countries. The impact of these issues in diagnosis, disease progression and susceptibility to ARV therapy was also investigated. Finally, the nature, dynamics and prevalence of transmitted drug resistance (TDR) was determined in untreated HIV-1 infected patients. In Angola, practically all HIV-1 genetic forms were found, including almost all subtypes, untypable (U) strains, CRFs and URFs. Recombinants (first and second generation) were present in 47.1% of the patients. HIV/AIDS epidemic in Angola probably started in 1961, the major cause being the independence war, subsequently spreading to Portugal. In Maputo, 81% of the patients were infected with subtype C viruses. Subtype G, U and recombinants such as CRF37_cpx, were also present. The results suggest that HIV-1 epidemic in Mozambique is evolving rapidly in genetic complexity. In Cape Verde, where HIV-1 and HIV-2 co-circulate, subtype G is the prevailed subtype. Subtypes B, C, F1, U, CRF02_AG and other recombinant strains were also found. HIV-2 isolates belonged to group A, some being closely related to the original ROD isolate. In all three countries numerous new polymorphisms were identified in the RT and PR of HIV-1 viruses. Mutations conferring resistance to the NRTIs or NNRTIs were found in isolates from 2 (2%) patients from Angola, 4 (6%) from Mozambique and 3 (12%) from Cape Verde. None of the isolates containing TDR mutations would be fully sensitive to the standard first-line therapeutic regimens used in these countries. Close surveillance in treated and untreated populations will be crucial to prevent further transmission of drug resistant strains and maximize the efficacy of ARV therapy. In Portugal, investigation of a seronegative case infection with rapid progression to AIDS and death revealed that the patient was infected with a CRF14_BG-like R5-tropic strain selectively transmitted by his seropositive sexual partner. The results suggest a massive infection with a highly aggressive CRF14_BG like strain and/or the presence of an unidentified immunological problem that prevented the formation of HIV-1-specific antibodies. Near full-length genomic sequences obtained from three unrelated patients enabled the first molecular and phylogenomic characterization of CRF14_BG from Portugal; all sequences were strongly related with CRF14_BG Spanish isolates. The mean date of origin of CRF14_BG was estimated to be 1992. We propose that CRF14_BG emerged in Portugal in the early 1990s, spread to Spain in late 1990s as a consequence of IDUs migration and then to the rest of Europe. Most CRF14_BG strains were predicted to use CXCR4 and were associated with rapid CD4 depletion and disease progression. Finally, we provide evidence suggesting that the X4 tropism of CRF14_BG may have resulted from convergent evolution of the V3 loop possibly driven by an effective escape from neutralizing antibody response.

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A competição intraespecífica e a ausência de hospedeiros podem comprometer o sucesso de programas de controle biológico. Assim, este trabalho objetivou avaliar o efeito de diferentes densidades de fêmeas (1, 3, 6 e 9 fêmeas/ 100 ovos) e da ausência de hospedeiro no parasitismo de Telenomus remus Nixon (Hymenoptera, Scelionidae) em ovos de Spodoptera frugiperda (J. E. Smith) (Lepidoptera, Noctuidae). Observou-se aumento no parasitismo de ovos de S. frugiperda por T. remus a partir da densidade 3 fêmeas/ 100 ovos tanto em condições de laboratório (18%) quanto em campo (32%), embora o parasitismo causado por densidades maiores que 1 fêmea/100 ovos não foi significativamente diferente. Todavia, isso não causou superparasitismo. Por outro lado, o número de fêmeas produzidas na progênie diminuiu (39%) com a maior densidade de fêmeas sob condições de laboratório. Contudo, não verificou-se diferença significativa sob condições de campo. Mesmo após 9 dias de ausência de hospedeiro não houve redução nos índices de parasitismo, permanecendo em torno de 95 ovos parasitados/fêmea/dia. Todavia, no décimo dia pode-se observar redução (40%) no número médio de ovos parasitados. Desse modo, a liberação de três fêmeas por 100 ovos é adequada para se obter elevados níveis de parasitismo.

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This paper provides a quantitative evaluation of the intra--cohortredistributive elements of the United States social security system in thecontext of a computable general equilibrium model. I determine how thewell--being of individuals that differ across {\sl gender, race} and {\sl education}is affected by government social security policy. I find that females, whitesand non--college graduates stand less to gain (lose) from reductions(increases) in the size of social security than males, non--whites andcollege graduates, respectively. Differences in mortality risk and laborproductivity translate into differences in the magnitudes of capitalaccumulation and labor supply distortions, that are responsible for theobserved welfare difference between types. Results imply that the currentprogram is lifetime progressive across gender and education, yet lifetimeregressive across race.

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This study investigates the intra-individual stability of the speed of several motor tasks and the intensity of associated movements in 256 children (131 girls, 125 boys) from the Zurich generational study using the Zurich neuromotor assessment battery (ZNA) over a 12-year period from the age of 6 to 18 years. The stability was assessed by correlograms of standard deviation scores calculated from age- and gender-adjusted normative values and compared with standing height and full scale intelligence quotient (IQ). While motor tasks of hand, finger and foot (HFT) and contralateral associated movements (CAM) exhibited a moderate stability (summary measure as correlation coefficients between two measurements made 4 years apart: .61 and .60), other tasks (dynamic balance, static balance and pegboard) were only weakly stable (.46, .47 and .49). IQ and height were more stable than neuromotor components (.72 and .86). We conclude that the moderately stable HFT and CAM may reflect "motor traits", while the stability of the pegboard and balance tasks is weaker because these skills are more experience related and state-dependent.

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The neuro-peptide hormone oxytocin regulates several reproductive mechanisms in mammals, such as uterine contractions during parturition and milk ejection in the lactating mammary gland. Oxytocin may also influence behavior and behavioral strategies, e.g. pair bonding, social recognition, maternal behavior, trust building, or anxiety. Teasing oestrous mares by a stallion provokes the release of oxytocin. We therefore tested whether such elevated oxytocin levels reveal possible mate preferences as determined in typical preference tests.

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Behavioral ecology of Heteragrion consors Hagen (Odonata: Megapodagrionidae): a shade-seek Atlantic forest damselfly. The intensity of the inter and intra-sexual selection can affect male behavioral traits as territorial fidelity and aggressiveness allowing the existence of different strategies. However, its differential success could be affected by environmental - as the diel variation in temperature - and physiological constrains - as the variation in thermoregulatory abilities. In this context, we present a behavioral analysis of Heteragrion consors (Zygoptera, Megapodagrionidae) trying to characterize its mating system, diel activity pattern, temporal budget, territoriality and reproductive biology. These data were obtained based on field observations using the focal individual method and mark-recapture techniques in 120 m of a shaded Atlantic Forest stream in Brazil. The males of this species were territorial, varying in its local fidelity, while the females appear sporadically. Males were perched in the majority of the time, but were also observed in cleaning movements, longitudinal abdominal flexion, wing flexion and sperm transfer during perch. The males presented a perched thermoregulatory behavior related to an exothermic regulation. Foraging and agonistic interactions were rare, but dominate the other behavioral activities. Abdominal movements associated to long lasting copula pointed to the existence of sperm competition in this species. Males performed contact post-copulatory guarding of the females. These observations pointed to a non-resource mating system for this species.

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Intra-puparial development of the females of Chrysomya albiceps (Wiedemann) (Diptera, Calliphoridae). The chronology and morphological changes that take place during intra-puparial development of Chrysomya albiceps is described based on 254 specimens reared in the laboratory. Larvae were obtained from the eggs laid by a single female. The pre-pupae were separated according to the reduction of larval length and the degree of pigmentation and sclerotization of the cuticle. After pupation, 10 individuals were fixed in Carnoy's solution and preserved in 70% ethanol, 10 individuals were fixed every 3 hours up to complete the first 24 hours (n = 80), the remaining individuals were fixed every six hours up to the 90th hour (n = 110) when 54 females emerged. The pupae were immersed in 5% formic acid for 48 hours and maintained in 70% ethanol, and then dissected and analyzed. C. albiceps shows four intra-puparial stages, each of which were described and compared with those described for Musca domestica, Calliphora erythrocephala, Sarcophaga bullata, Cuterebra tenebrosa, Oestrus ovis and Dermatobia hominis. Four developmental stages may be described: (1) the larva-pupa apolysis, after three hours; (2) the criptocephalic pupa, after six hours; (3) the phanerocephalic pupa, after nine hours; (4) the pharate pupa, after nine hours. The pharate adult is completely formed after 81 hours.