Hypotheses, rationale, design, and methods for prognostic evaluation in type 2 diabetic patients with angiographically normal coronary arteries. The MASS IV-DM Trial

Background: The MASS IV-DM Trial is a large project from a single institution, the Heart Institute (InCor), University of Sao Paulo Medical School, Brazil to study ventricular function and coronary arteries in patients with type 2 diabetes mellitus. Methods/Design: The study will enroll 600 patients with type 2 diabetes who have angiographically normal ventricular function and coronary arteries. The goal of the MASS IV-DM Trial is to achieve a long-term evaluation of the development of coronary atherosclerosis by using angiograms and coronary-artery calcium scan by electron-beam computed tomography at baseline and after 5 years of follow-up. In addition, the incidence of major cardiovascular events, the dysfunction of various organs involved in this disease, particularly microalbuminuria and renal function, will be analyzed through clinical evaluation. In addition, an effort will be made to investigate in depth the presence of major cardiovascular risk factors, especially the biochemical profile, metabolic syndrome inflammatory activity, oxidative stress, endothelial function, prothrombotic factors, and profibrinolytic and platelet activity. An evaluation will be made of the polymorphism as a determinant of disease and its possible role in the genesis of micro- and macrovascular damage. Discussion: The MASS IV-DM trial is designed to include diabetic patients with clinically suspected myocardial ischemia in whom conventional angiography shows angiographically normal coronary arteries. The result of extensive investigation including angiographic follow-up by several methods, vascular reactivity, pro-thrombotic mechanisms, genetic and biochemical studies may facilitate the understanding of so-called micro- and macrovascular disease of DM.

Effects of Gastric Bypass Surgery in Patients With Type 2 Diabetes and Only Mild Obesity

OBJECTIVE-Roux-en-Y gastric bypass (RYGB) ameliorates type 2 diabetes in severely obese patients through mechanisms beyond just weight loss, and it may benefit less obese diabetic patients. We determined the long-term impact of RYGB on patients with diabetes and only class 1 obesity. RESEARCH DESIGN AND METHODS-Sixty-six consecutively selected diabetic patients with BMI 30-35 kg/m(2) underwent RYGB in a tertiary-care hospital and were prospectively studied for up to 6 years (median 5 years [range 1-6]), with 100% follow-up. Main outcome measures were safety and the percentage of patients experiencing diabetes remission (HbA(1c) <6.5% without diabetes medication). RESULTS-Participants had severe, longstanding diabetes, with disease duration 12.5 +/- 7.4 years and HbA(1c) 9.7 +/- 1.5%, despite insulin and/or oral diabetes medication usage in everyone. For up to 6 years following RYGB, durable diabetes remission occurred in 88% of cases, with glycemic improvement in 11%. Mean HbA(1c) fell from 9.7 +/- 1.5 to 5.9 +/- 0.1% (P < 0.001), despite diabetes medication cessation in the majority. Weight loss failed to correlate with several measures of improved glucose homeostasis, consistent with weight-independent antidiabetes mechanisms of RYGB. C-peptide responses to glucose increased substantially, suggesting improved beta-cell function. There was no mortality, major surgical morbidity, or excessive weight loss. Hypertension and dyslipidemia also improved, yielding 50-84% reductions in predicted 10-year cardiovascular disease risks of fatal and nonfatal coronary heart disease and stroke. CONCLUSIONS-This is the largest, longest-term study examining RYGB for diabetic patients without severe obesity. RYGB safely and effectively ameliorated diabetes and associated comorbidities, reducing cardiovascular risk, in patients with a BMI of only 30-35 kg/m(2).

Choosing the Path of Austerity: How Policy Coalitions Shape Welfare-policy Choices in Periods of Fiscal Consolidation

In general, fiscal adjustments are associated with significant reductions in social spending. Hence, the welfare state is not spared from austerity. Because the welfare state is still central to party competition, this is electorally risky. The paper addresses the following questions: Do left parties differ from their centrist and rightist competitors in the design of austerity measures? And does government type has an impact on the extent to which austerity policies rely on social spending cuts? By comparing 17 OECD countries between 1982 and 2009 we show that if governments embark on a path to austerity, their ideology does not have a significant effect on the magnitude of welfare state retrenchment. However, if major opposition parties and interest groups rally against social spending cuts, a broad pro-reform coalition is a crucial precondition for large fiscal consolidation programs to rely on substantial cuts to social security.

Promoting health in families of children with type 1 diabetes mellitus

This paper presents a study of families of children with type 1 diabetes mellitus, emphasizing the identification of social supports and networks to strengthen interventions aimed at health promotion. The approach selected was a qualitative research, using a case study design. Four families of children with diabetes type 1 were studied, totalling seven participants. Data were collected between April and June 2007, through in-depth interviews and the construction of a genogram and an ecomap. The results presented the families` characterization and testimonies grouped in the following categories: social support, social networks and family roles. To promote care in practice, there is a need to identify the characteristics of each family and resources available that provide better living conditions. We concluded that identifying supports and social networks allows for more personalized care delivery to each family with a view to health promotion.

Formação em Universal Design for Learning

Na qualidade de Diretora Regional das Comunidades, fomos responsável pela redação dos artigos e coordenação da página "Comunidades", integrada no jornal Açoriano Oriental, servindo a mesma para a divulgação das atividades realizadas pela Direção Regional Das Comunidades do Governo dos Açores.

Estimating Design-Flood Discharges for Streams in Iowa Using Drainage-Basin and Channel-Geometry Characteristics, HR-322, 1993

Drainage-basin and channel-geometry multiple-regression equations are presented for estimating design-flood discharges having recurrence intervals of 2, 5, 10, 25, 50, and 100 years at stream sites on rural, unregulated streams in Iowa. Design-flood discharge estimates determined by Pearson Type-III analyses using data collected through the 1990 water year are reported for the 188 streamflow-gaging stations used in either the drainage-basin or channel-geometry regression analyses. Ordinary least-squares multiple-regression techniques were used to identify selected drainage-basin and channel-geometry regions. Weighted least-squares multiple-regression techniques, which account for differences in the variance of flows at different gaging stations and for variable lengths in station records, were used to estimate the regression parameters. Statewide drainage-basin equations were developed from analyses of 164 streamflow-gaging stations. Drainage-basin characteristics were quantified using a geographic-information-system (GIS) procedure to process topographic maps and digital cartographic data. The significant characteristics identified for the drainage-basin equations included contributing drainage area, relative relief, drainage frequency, and 2-year, 24-hour precipitation intensity. The average standard errors of prediction for the drainage-basin equations ranged from 38.6% to 50.2%. The GIS procedure expanded the capability to quantitatively relate drainage-basin characteristics to the magnitude and frequency of floods for stream sites in Iowa and provides a flood-estimation method that is independent of hydrologic regionalization. Statewide and regional channel-geometry regression equations were developed from analyses of 157 streamflow-gaging stations. Channel-geometry characteristics were measured on site and on topographic maps. Statewide and regional channel-geometry regression equations that are dependent on whether a stream has been channelized were developed on the basis of bankfull and active-channel characteristics. The significant channel-geometry characteristics identified for the statewide and regional regression equations included bankfull width and bankfull depth for natural channels unaffected by channelization, and active-channel width for stabilized channels affected by channelization. The average standard errors of prediction ranged from 41.0% to 68.4% for the statewide channel-geometry equations and from 30.3% to 70.0% for the regional channel-geometry equations. Procedures provided for applying the drainage-basin and channel-geometry regression equations depend on whether the design-flood discharge estimate is for a site on an ungaged stream, an ungaged site on a gaged stream, or a gaged site. When both a drainage-basin and a channel-geometry regression-equation estimate are available for a stream site, a procedure is presented for determining a weighted average of the two flood estimates.

Introduction to Game Design and Development

This is the introductory lecture to COMP3218. We introduce ourselves, cover the philosophy of the course, the structure and assessment process, and lead an initial game design exercise.

Variation of System Performance with Design and Climate for Combisystems in Sweden

In Sweden, 90% of the solar heating systems are solar domestic hot water and heating systems (SDHW&H), so called combisystems. These generally supply most of the domestic hot water needs during the summer and have enough capacity to supply some energy to the heating system during spring and autumn. This paper describes a standard Swedish combisystem and how the output from it varies with heating load, climate within Sweden, and how it can be increased with improved system design. A base case is defined using the standard combi- system, a modern Swedish single family house and the climate of Stockholm. Using the simulation program Trnsys, parametric studies have been performed on the base case and improved system designs. The solar fraction could be increased from 17.1% for the base case to 22.6% for the best system design, given the same system size, collector type and load. A short analysis of the costs of changed system design is given, showing that payback times for additional investment are from 5-8 years. Measurements on system components in the laboratory have been used to verify the simulation models used. More work is being carried out in order to find even better system designs, and further improvements in system performance are expected.

Designens betydelse vid val av boxvin : En studie om konsumenters preferenser av designfaktorer på bag-in-box-vin.

På den svenska marknaden står bag-in-box-vin för över 50 procent av allt vin som säljs och Sverige är det land där bag-in-boxen fått starkast fäste i världen (Fremin, 2012). Det gör att bag-in-box-förpackningen är en stor och betydelsefull produkt för vintillverkare och att ha kunskap om säljande design är viktigt för grafiska formgivare samt övriga involverade företag. Den föreliggande studiens syfte var att undersöka vilka designfaktorer på bagin- box-förpackningar som påverkar konsumenternas val av vin i Sverige. Studien innefattade en visuell kartläggning som ämnade ge en överblick av utbudet på ett Systembolag. Detta genomfördes för att skapa en grund till den webbaserade enkätundersökningen som genomfördes under våren 2015. Resultaten visade att majoriteten av respondenterna valde vin baserat på förpackningens utseende och ansåg att de påverkades främst av färg, typsnitt, illustrationer och varumärken. Resultaten visade också att ju högre vinkunskap konsumenterna hade desto mindre påverkade designen deras val. Kvinnor och män hade generellt olika åsikter angående hur stor påverkan de olika designfaktorerna hade vid valet av bag-in-box-vin. Denna studie är endast ett avstamp till ett ämne som innefattar många påverkande faktorer. Det betyder att mer forskning krävs inom ämnet innan helt sanningsenliga resultat kan fastställas.

A small scale Multi-effect Distillation (MED) unit for rural micro enterprises:part I-design and fabrication

Removal of dissolved salts and toxic chemicals in water, especially at a few parts per million (ppm) levels is one of the most difficult problems. There are several methods used for water purification. The choice of the method depends mainly on the level of feed water salinity, source of energy and type of contaminants present. Distillation is an age old method which can remove all types of dissolved impurities from contaminated water. In multiple effect distillation (MED) latent heat of steam is recycled several times to produce many units of distilled water with one unit of primary steam input. This is already being used in large capacity plants for treating sea water. But the challenge lies in designing a system for small scale operations that can treat a few cubic meters of water per day, especially suitable for rural communities where the available water is brackish. A small scale MED unit with an extendable number of effects has been designed and analyzed for optimum yield in terms of total distillate produced. © 2010 Elsevier B.V.

Surrogate-based analysis and optimization for the design of heat sinks with jet impingement

Heat sinks are widely used for cooling electronic devices and systems. Their thermal performance is usually determined by the material, shape, and size of the heat sink. With the assistance of computational fluid dynamics (CFD) and surrogate-based optimization, heat sinks can be designed and optimized to achieve a high level of performance. In this paper, the design and optimization of a plate-fin-type heat sink cooled by impingement jet is presented. The flow and thermal fields are simulated using the CFD simulation; the thermal resistance of the heat sink is then estimated. A Kriging surrogate model is developed to approximate the objective function (thermal resistance) as a function of design variables. Surrogate-based optimization is implemented by adaptively adding infill points based on an integrated strategy of the minimum value, the maximum mean square error approach, and the expected improvement approaches. The results show the influence of design variables on the thermal resistance and give the optimal heat sink with lowest thermal resistance for given jet impingement conditions.

Projecto de entreposto frigorífico a R-744/R-717 para produtos congelados

Pretende-se com este trabalho de Projecto de Mestrado conceber uma câmara frigorífica de 20000 m3 para armazenar produtos congelados e estudar um sistema frigorífico com dois fluidos frigorigénios que serão o CO2 (R-744) e o NH3 (R-717) O trabalho inicia-se com a definição dos objectivos principais para o projecto de um sistema frigorífico deste tipo. Após a definição dos objectivos, o projecto propõe um estudo termodinâmico do CO2 (R-744) como fluido frigorigénio, definindo se o seu historial de utilização, características principais, diagrama pressão-entalpia com a distinção das diversas fases do fluído, comparação em diversos parâmetros com outros fluidos, o porquê da utilização deste fluído, problemas comuns em sistemas com a presença deste fluído, entre outros parâmetros de estudo. De seguida será feito o dimensionamento de uma câmara frigorífica de 20000 m3 para armazenar produtos congelados paletizados através de um balanço térmico manual e um balanço térmico informático através do programa da Centauro comparando no final o resultado dos dois métodos. Será feito uma descrição das características básicas da câmara frigorífica com um esquema simples do edifício. Será abordado de seguida o sistema frigorífico a CO2 (R-744) e a NH3 (R-717) nas suas diversas características, nomeadamente no cálculo de caudais, diagrama pressão-entalpia, dimensionamento de tubagens e finalmente selecção de equipamento. Procede-se assim também ao estudo um sistema apenas a NH3 (R-717) com as suas diversas características nomeadamente no cálculo de caudais, diagrama pressão-entalpia, dimensionamento de tubagens e finalmente selecção dos equipamentos mais importantes, para que desta forma se proceda à comparação dos dois sistemas a nível energético, consumo eléctrico e manutenção de equipamentos. Finalmente proceder-se-á interpretação de resultados com o objectivo final de escolher a melhor solução nos vários parâmetros de comparação, para o esquema em questão.

Working hours, work-life conflict and health in precarious and "permanent" employment

OBJECTIVE: The expansion of precarious employment in OECD countries has been widely associated with negative health and safety effects. Although many shiftworkers are precariously employed, shiftwork research has concentrated on full-time workers in continuing employment. This paper examines the impact of precarious employment on working hours, work-life conflict and health by comparing casual employees to full-time, "permanent" employees working in the same occupations and workplaces. METHODS: Thirty-nine convergent interviews were conducted in two five-star hotels. The participants included 26 full-time and 13 casual (temporary) employees. They ranged in age from 19 to 61 years and included 17 females and 22 males. Working hours ranged from zero to 73 hours per week. RESULTS: Marked differences emerged between the reports of casual and full-time employees about working hours, work-life conflict and health. Casuals were more likely to work highly irregular hours over which they had little control. Their daily and weekly working hours ranged from very long to very short according to organisational requirements. Long working hours, combined with low predictability and control, produced greater disruption to family and social lives and poorer work-life balance for casuals. Uncoordinated hours across multiple jobs exacerbated these problems in some cases. Health-related issues reported to arise from work-life conflict included sleep disturbance, fatigue and disrupted exercise and dietary regimes. CONCLUSIONS:This study identified significant disadvantages of casual employment. In the same hotels, and doing largely the same jobs, casual employees had less desirable and predictable work schedules, greater work-life conflict and more associated health complaints than "permanent" workers.

System Level Simulation and Radio Resource Management for Distributed Antenna Systems with Cognitive Radio and Multi-Cell Cooperation

4th International Conference on Future Generation Communication Technologies (FGCT 2015), Luton, United Kingdom.

Controlo inteligente de um Sistema de Levitação Magnética

A levitação magnética tem sido um tema bastante investigado sobretudo devido à sua utilização em sistemas ferroviários de transportes. É o método ideal quando existe a necessidade em aplicações de restringir do contacto físico, ou a conveniência, em termos energéticos, de eliminar o atrito. O princípio de funcionamento é simples, um eletroíman cria uma força sobre um objeto ferromagnético que contraria a gravidade. Contudo um sistema de levitação por atração é instável e não linear, o que significa a necessidade de implementar um controlador para satisfazer as características de estabilidade desejadas. Ao longo deste projeto serão descritos os procedimentos teóricos e práticos que foram tomados na criação de um sistema de levitação eletromagnética. Desde a conceção física do sistema, como escolha do sensor, condicionamento de sinal ou construção do eletroíman, até aos procedimentos matemáticos que permitiram a modelação do sistema e criação de controladores. Os controladores clássicos, como o PID ou em avanço de fase, foram projetados através da técnica do Lugar Geométrico de Raízes. No projeto do controlador difuso, pelo contrário não se fez uso da modelação do sistema ou de qualquer relação matemática entre as variáveis. A utilização desta técnica de controlo destacou-se pela usa simplicidade e rapidez de implementação, fornecendo um bom desempenho ao sistema. Na parte final do relatório os resultados obtidos pelos diferentes métodos de controlo são analisados e apresentadas as respetivas conclusões. Estes resultados revelam que para este sistema, relativamente aos outros métodos, o controlador difuso apresenta o melhor desempenho tanto ao nível da resposta transitória, como em regime permanente.