Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian Cohort

Background: The maternal cardiovascular system undergoes progressive adaptations throughout pregnancy, causing blood pressure fluctuations. However, no consensus has been established on its normal variation in uncomplicated pregnancies. Objective: To describe the variation in systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels during pregnancy according to early pregnancy body mass index (BMI). Methods: SBP and DBP were measured during the first, second and third trimesters and at 30-45 days postpartum in a prospective cohort of 189 women aged 20-40 years. BMI (kg/m2) was measured up to the 13th gestational week and classified as normal-weight (<25.0) or excessive weight (≥25.0). Longitudinal linear mixed-effects models were used for statistical analysis. Results: A decrease in SBP and DBP was observed from the first to the second trimester (βSBP=-0.394; 95%CI: -0.600- -0.188 and βDBP=-0.617; 95%CI: -0.780- -0.454), as was an increase in SBP and DBP up to 30-45 postpartum days (βSBP=0.010; 95%CI: 0.006-0.014 and βDBP=0.015; 95%CI: 0.012-0.018). Women with excessive weight at early pregnancy showed higher mean SBP in all gestational trimesters, and higher mean DBP in the first and third trimesters. Excessive early pregnancy BMI was positively associated with prospective changes in SBP (βSBP=7.055; 95%CI: 4.499-9.610) and in DBP (βDBP=3.201; 95%CI: 1.136-5.266). Conclusion: SBP and DBP decreased from the first to the second trimester and then increased up to the postpartum period. Women with excessive early pregnancy BMI had higher SBP and DBP than their normal-weight counterparts throughout pregnancy, but not in the postpartum period.

La experiencia de los receptores en el trasplante de órganos y tejidos

El trasplante de órganos y/o tejidos es considerado como una opción terapéutica viable para el tratamiento tanto de enfermedades crónicas o en estadios terminales, como de afectaciones no vitales, pero que generen una disminución en la calidad de vida percibida por el paciente. Este procedimiento, de carácter multidimensional, está compuesto por 3 actores principales: el donante, el órgano/tejido, y el receptor. Si bien un porcentaje significativo de investigaciones y planes de intervención han girado en torno a la dimensión biológica del trasplante, y a la promoción de la donación; el interés por la experiencia psicosocial y la calidad de vida de los receptores en este proceso ha aumentado durante la última década. En relación con esto, la presente monografía se plantea como objetivo general la exploración de la experiencia y los significados construidos por los pacientes trasplantados, a través de una revisión sistemática de la literatura sobre esta temática. Para ello, se plantearon unos objetivos específicos derivados del general, se seleccionaron términos o palabras claves por cada uno de estos, y se realizó una búsqueda en 5 bases de datos para revistas indexadas: Ebsco Host (Academic Search; y Psychology and Behavioral Sciences Collection); Proquest; Pubmed; y Science Direct. A partir de los resultados, se establece que si bien la vivencia de los receptores ha comenzado a ser investigada, aún es necesaria una mayor exploración sobre la experiencia de estos pacientes; exploración que carecería de objetivo si no se hiciera a través de las narrativas o testimonios de los mismos receptores

Supervivencia en pacientes con trasplante hepático realizado en la Fundación Cardioinfantil entre 2005 y 2013

Introducción: El trasplante hepático es la terapia de elección para los pacientes con enfermedad hepática terminal, logrando mejorar su expectativa y calidad de vida, de acuerdo a estudios realizados en otros países. En la Fundación Cardioinfantil – Instituto de Cardiología (FCI-IC) se han realizado 332 trasplantes hepáticos hasta el 2014, pero no se conoce la supervivencia y los factores pronósticos propios de los pacientes intervenidos. Objetivo Principal: Estimar la supervivencia a 1, 3 y 5 años e identificar los principales factores pronósticos de los pacientes a quienes se les realizó trasplante hepático en el periodo 2005-2013 en la FCI-IC. Método: Estudio observacional y retrospectivo, basado en revisión de historias clínicas de los pacientes adultos a quienes se les realizó trasplante hepático en el periodo 2005-2013 en la FCI-IC. Resultados: La supervivencia al año fue de 90.91% (IC95% 86.40-93.98), a los 3 años 83.64% (IC95% 77.89-88.01) y a los 5 años de 79.18% (IC95% 72.54-84.39). Los principales factores pronósticos fueron el antecedente de ascitis (HR 2.449, IC 1.252 – 4.792), la edad del donante (HR 1.040, IC 1.009 – 1.071) y el receptor (HR 1.037, IC 1.014 – 1.060). Se encontró una mayor supervivencia en los pacientes con cirrosis alcohólica (HR 0.099, IC 0.021 – 0.467). Conclusiones: El estudio mostró una supervivencia mayor a la reportada en estudios realizados en Estados Unidos (67.4-73.0% a los 5 años) y España (73,3% a los 3 años) y similar a la de Chile (80.0% a los 5 años). Cabe resaltar que estos estudios incluyeron series más grandes de pacientes.

Respuesta inflamatoria sistémica en el donante como predictor de infección en el primer mes del trasplante renal

Introducción: El objetivo principal de la selección del donante es disminuir la posibilidad de transmisión de enfermedades infecciosas o neoplásicas en el receptor. De forma cruda se calcula que aproximadamente el 50% de los potenciales donantes son contraindicados, la mayoría por infección. La alta demanda de órganos obliga a revalorar las contraindicaciones que hasta hace poco eran absolutas, el reto es diferenciar el SIRS del donante por Muerte Encefálica con el SIRS por infecciones. Método: Estudio de cohorte retrospectivo; que busca evaluar la respuesta inflamatoria sistémica (SIRS) como predictor de infección en pacientes con trasplante renal en el primer mes pos trasplante. Resultados: El contraste de hipótesis proporciono una significancia bilateral (P= 0,071). La pruebas de hipótesis aceptaron la hipótesis nula (P= 0,071), que no existe asociación entre la presencia de SIRS en el donante con la incidencia de infección en el primer mes del pos trasplante renal. La estimación del riesgo de no reingreso por infección al primer mes pos trasplante renal es de 0.881 veces para los donantes con SIRS (IC 0.757 – 1.025). Conclusión: A pesar de no encontrar significancia estadística: el SIRS en el donante no se asocia con un aumento en la incidencia de infección en el primer mes postrasplante. Para encontrar la significancia se propone un estudio con un tamaño de muestra mayor.

Final environmental statement : crude oil transportation systems (proposed under Public Law 95-617, the Public utility regulatory policies act of 1978), Northern Tier Pipeline Company, Northwest Energy Company, Kitimat Pipe Line Ltd., Trans Mountain Oil Pipe Line Corporation /

Bibliography: p. R-1 - R-19, v.3.

The effects of the Cannabis Expiation Notice System on the prevalence of cannabis use in South Australia: evidence from the National Drug Strategy Household Surveys 1985-95

This study sought to examine the impact of the Cannabis Expiation Notice (CEN) scheme on the prevalence of lifetime and weekly cannabis use in South Australia. Data from five National Drug Strategy Household Surveys between 1985 and 1995 were examined to test for differences in trends in self-reported: (1) lifetime cannabis use; and (2) current weekly cannabis use, after controlling for age and gender, between South Australia and the other states and territories. Between 1985 and 1995, rates of lifetime cannabis use increased in SA from 26% to 36%. There were also significant increases in Victoria (from 26% to 32%), Tasmania (from 21% to 33%) and New South Wales (from 26% to 33%). The increase in South Australia was significantly greater than the average increase throughout the rest of Australia, but the other Australian states differed in their rates of change. Victoria and Tasmania had similar rates of increase to South Australia; New South Wales, Queensland and Western Australia showed lower rates of increase; and the Northern Territory and the Australian Capital Territory had high rates that did not change during the period. There was no statistically significant difference between SA and the rest of Australia in the rate of increase in weekly cannabis use. While there was a greater increase in self- reported lifetime cannabis use in South Australia between 1985 and 1995 than in the average of the other Australian jurisdictions it is unlikely that this increase is due to the CEN system, because similar increases occurred in Tasmania and Victoria (where there was no change in the legal status of cannabis use), and there was no increase in the rate of weekly cannabis use in South Australia over the same period.

Body mass index and risk of head and neck cancer in a pooled analysis of case-control studies in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium

Methods We pooled data from 17 case-control studies including 12 716 cases and the 17 438 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for associations between body mass index (BMI) at different ages and HNC risk, adjusted for age, sex, centre, race, education, tobacco smoking and alcohol consumption. Results Adjusted ORs (95% CIs) were elevated for people with BMI at reference (date of diagnosis for cases and date of selection for controls) < 18.5 kg/m(2) (2.13, 1.75-2.58) and reduced for BMI > 25.0-30.0 kg/m(2) (0.52, 0.44-0.60) and BMI >= 30 kg/m(2) (0.43, 0.33-0.57), compared with BMI > 18.5-25.0 kg/m(2). These associations did not differ by age, sex, tumour site or control source. Although the increased risk among people with BMI < 18.5 kg/m(2) was not modified by tobacco smoking or alcohol drinking, the inverse association for people with BMI > 25 kg/m(2) was present only in smokers and drinkers. Conclusions In our large pooled analysis, leanness was associated with increased HNC risk regardless of smoking and drinking status, although reverse causality cannot be excluded. The reduced risk among overweight or obese people may indicate body size is a modifier of the risk associated with smoking and drinking. Further clarification may be provided by analyses of prospective cohort and mechanistic studies.

Closure of the Challinor Centre II: An extended report on 95 individuals after 12 months of community living

As part of an institutional closure programme, 95 individuals with an intellectual disability were relocated to community-based group homes. Each individual was assessed 6 months prior to the relocation and then again after 1, 6, and 12 months of community living. Assessments involved ratings of adaptive and maladaptive behaviour, choice-making, and life circumstances. The group means comparing institution to community ratings showed improvements in adaptive functioning but no significant change in maladaptive behaviour. There were also improvements in life circumstances and increased opportunities for choice-making following relocation to the community. These outcomes suggest that relocation to the community was associated with a more active and normalised lifestyle than experienced in the institutional setting.

Alcohol, tobacco and breast cancer - collaborative reanalysis of individual data from 53 epidemiological studies, including 58 515 women with breast cancer and 95 067 women without the disease

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58515 women with invasive breast cancer and 95067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19 - 1.45, P < 0.00001) for an intake of 35 - 44 g per day alcohol, and 1.46 (1.33 - 1.61, P < 0.00001) for greater than or equal to 45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P

NOVA ANOTAÇÃO SINTÉTICA, NUMA PERSPECTIVA DE DIREITO PÚBLICO, AINDA AO ACÓRDÃO 212/95, DO TRIBUNAL CONSTITUCIONAL (PORTUGUÊS), DE 20.04.1995 - O DEVER FUNDAMENTAL DE EXISTIR NA LEI EM VIGOR UMA RESPONSABILIDADE CRIMINAL DAS "PESSOAS COLECTIVAS" (OU "PESSOAS JURÍDICAS") E A CONSTITUIÇÃO DA REPÚBLICA PORTUGUESA, V.G. O CASO DO ART. 7º DO REGIME GERAL DAS INFRACÇÕES TRIBUTÁRIAS E DO ART. 3.º DO REGIME DAS INFRACÇÕES ANTIECONÓMICAS E CONTRA A SAÚDE PÚBLICA

Resumo: 1 – Sumário do Acórdão do Tribunal Constitucional n.º 212/1995, de 20 de Abril; 2 – Parte principal do Acórdão do Tribunal Constitucional n.º 212/1995, de 20 de Abril: cfr. http://www.tribunalconstitucional.pt/tc/acordaos/19950212.html , 18 de Maio de 2012; 3 – Anotação sintética; 3.1 – Introdução à anotação sintética e suas características neste caso concreto; 4 – O RIAECSP (Regime das Infracções Anti-Económicas e Contra a Saúde Pública) e a responsabilidade criminal das pessoas colectivas e equiparadas, prevista no seu art. 3.º; 5 – Societas delinquere non potest?; 6 – Breves traços históricos do brocardo societas delinquere non potest; 7 - Alguns dos marcos relevantes na Doutrina penal portuguesa recente acerca da responsabilidade penal das organizações, entes colectivos, pessoas colectivas, pessoas jurídicas; 8 - Os art.os 12.º/2 e 2.º da CRP e a Responsabilidade Criminal dos Entes Colectivos, pessoas jurídicas; 9 - O art. 29.º/5 da CRP - ou o princípio non bis in idem - e a responsabilidade criminal das organizações, dos entes colectivos, das pessoas colectivas; 10 – Conclusões. § Summary: 1 - Summary Judgment of the Constitutional Court No. 212/1995 of 20 April; 2 - The main part of the Constitutional Court Ruling No. 212/1995 of 20 April: cfr. http://www.tribunalconstitucional.pt/tc/acordaos/19950212.html, May 18, 2012; 3 - short annotation; 3.1 - Introduction to synthetic note and its features in this particular case; 4 - The RIAECSP (Status of Anti-Economic Offences and Against Public Health) and the criminal liability of companies and similar persons, provided for in his art. 3; 5 - delinquere Societas non potest ?; 6 - Brief historical traces of societas aphorism delinquere non potest; 7 - Some of the important milestones in recent Portuguese criminal Doctrine about the criminal liability of organizations, public entities, legal persons, legal entities; 8 - art.os 12/2 and 2 of CRP and Criminal Responsibility of loved Collective, legal entities; 9 - Art. 29/5 CRP - or the principle of non bis in idem - and the criminal liability of organizations, collective entities, of legal persons; 10 - Conclusions.

Empreitada de construção de 95 moradias no empreendimento Tróia Resort

O sector da construção é sem dúvida um dos que mais contribui para a criação de emprego, representando um valor significativo em termos de produto interno bruto. Muitas vezes a preocupação excessiva com a gestão financeira e do tempo, leva a que as soluções preconizadas na fase de projecto não sejam devidamente amadurecidas e que em obra não se dê a atenção necessária à componente técnica. Estas questões reflectem-se na qualidade da construção e nos custos que as empresas têm que suportar em termos de serviço pós venda durante o período de garantia da obra. Tendo em conta que o aluno desenvolveu a sua actividade profissional nesta área nos últimos 14 anos, o que lhe dará uma base de trabalho para o tema a desenvolver, pretende-se demonstrar a importância de cada uma das áreas da Direcção Técnica e Gestão de Empreitadas, bem como a interligação que tem de existir entre as mesmas, por forma a que o resultado final seja um sucesso pleno. No caso concreto da obra que o aluno propõe para estudo, trata-se de um complexo de 95 moradias com 8 projectos distintos onde as soluções técnicas são bastante diversas e pouco vulgares, o que terá bastante interesse para um trabalho desta natureza

Replica management in real-time Ada 95 applications

In this paper, we present some of the fault tolerance management mechanisms being implemented in the Multi-μ architecture, namely its support for replica non-determinism. In this architecture, fault tolerance is achieved by node active replication, with software based replica management and fault tolerance transparent algorithms. A software layer implemented between the application and the real-time kernel, the Fault Tolerance Manager (FTManager), is the responsible for the transparent incorporation of the fault tolerance mechanisms The active replication model can be implemented either imposing replica determinism or keeping replica consistency at critical points, by means of interactive agreement mechanisms. One of the Multi-μ architecture goals is to identify such critical points, relieving the underlying system from performing the interactive agreement in every Ada dispatching point.

Multi-μ: an Ada 95 based architecture for fault tolerance support of real-time systems

This paper presents an architecture (Multi-μ) being implemented to study and develop software based fault tolerant mechanisms for Real-Time Systems, using the Ada language (Ada 95) and Commercial Off-The-Shelf (COTS) components. Several issues regarding fault tolerance are presented and mechanisms to achieve fault tolerance by software active replication in Ada 95 are discussed. The Multi-μ architecture, based on a specifically proposed Fault Tolerance Manager (FTManager), is then described. Finally, some considerations are made about the work being done and essential future developments.