Prediction of small for gestation neonates from biophysical and biochemical markers at 35-37 gestational weeks

Small for gestational age (SGA) is common in pregnancy and it has been associated with an increase in adverse perinatal outcomes, predisposition for neurological and cognitive delay in childhood and cardiovascular and endocrine diseases in adulthood. The classification is not consensual, having been defined in different studies as estimated fetal weight, abdominal circumference or birthweight below the 10th, 5th or 3rd percentiles, with the prevalence varying with the definition that is used. The increased risk of perinatal mortality and morbidity can be substantially reduced in cases identified prenatally, as close monitoring, timely delivery and prompt neonatal care can be undertaken, in comparison to those cases detected after birth. Over time, several screening methods have been introduced, in order to optimize the detection rate for SGA. These approaches range from abdominal palpation, symphyseal-fundal height measurement, fetal biometries, uterine artery doppler assessment and, more recently, biochemical markers. The aim of this thesis is to develop a model for prediction of SGA neonates in the absence of pre-eclampsia, based on maternal characteristics, clinical history, fetal biometry, uterine pulsatility index (Ut PI), mean arterial blood pressure (MAP) and serum biochemical markers (serum placental growth factor: PlGF; Soluble fms-like tyrosine kinase-1: sFlt-1) at 35-37 gestational weeks. This was a prospective screening project for detection of SGA neonates, in women attending for their third-trimester hospital visit in pregnancy at King's College Hospital (London) and Medway Maritime Hospital (Kent). The project comprised three studies. The first study included biophysical measurements of 5515 pregnant women, including 278 that delivered SGA (<5th) neonates. A SGA predictive model was developed based on the combination of maternal factors, clinical history and estimated fetal weight. In the second study, a subset of 5121 pregnant women was evaluated, 245 of which had SGA (<5th) newborns. A model was developed based on the combination of maternal factors, clinical history, estimated fetal weight, mean arterial pressure and uterine artery 9 dopplers. It was found that the additional use of mean arterial pressure and pulsatility index of the uterine arteries did not significantly improve the performance of screening for delivery of SGA neonates in comparison to the first study. In the third study, a subset of 3859 pregnant women was evaluated, comprising 158 SGA newborns. The SGA prediction model combined the following parameters: maternal factors, estimated fetal weight and biochemical values (serum placental growth factor, PlGF; fms-like soluble tyrosine kinase-1, sFlt-1). It was found that sFlt-1, when combined with maternal factors and fetal biometries, did not remain an independent factor in this predictive model. Additionally, serum PlGF only marginally improved the SGA screening performance when compared to the model of the first study. Hence, based on the findings, the best prediction was provided by the combination of maternal factors, estimated fetal weight and serum placental growth factor (PlGF). This combined screening predicted, at a 10% false positive rate, 88, 96 and 94% of SGA neonates with birth weight below the 10th, 5th and 3rd percentiles delivering at <2 weeks following assessment. The respective values for SGA delivering ≥37 weeks were 64, 75 and 80%. In conclusion, combined screening by maternal factors, biophysical and biochemical markers at 35-37 weeks can identify a high percentage of pregnancies that will deliver SGA neonates.European Union 7th Framework Programme - FP7-HEALTH-2013-INNOVATION-2 (ASPRE Project #601852)The Fetal Medicine Foundation (Charity No: 1037116)Roche Diagnostics Limite

La estructura verde en el proceso de planificación urbana

Los espacios naturales y la estructura verde urbana son partes esenciales de los tejidos con los cuales, en sus diferentes morfologías y niveles de centralidad, las ciudades se organizan, construyen y funcionan. La presencia de elementos naturales resulta de la aplicación de diversos criterios de ordenación de territorial o, simplemente, de decisiones pragmáticas de gestión de os recursos. La presencia de elementos naturales en el paisaje urbano permite que los procesos de urbanización y de rehabilitación y regeneración de los tejidos urbanos consolidados ocurran con blÜO nivel de estrés y más respeto de los equilibrios ambientales que contribuyen a la sostenibilidad urbana. El sistema de espacios abiertos creado por la presencia de elementos naturales permite la existencia de corredores eco lógicos para la conservación de la biodiversidad territorial y la creación y organización de la estructura verde urbana. Lo que significa que organizar la expansión o la recalificación de las ciudades es más que todo integrar el natural y el construido en una entidad con identidad, estructura y modo de funcionamiento propio.Natural areas and urban green structure are essential parts of the urban tissues with which, in their different morphologies and central levels, cities are organized, built and operated. The presence of natural elements results of the implementation of various approaches to land management, or simply pragmatic decisions you resources management. The presence of natural elements in the urban landscape allows low stress processes of urbanization and rehabilitation and regeneration and more respect to the environmental balance that contribute to urban sustainability. The open spaces system created by the presence of natural elements allows the existence of ecological corridors for biodiversity conservation, land and building structure and urban green areas organization. What means that to organize urban expansion or requalification is above all to integrate nature and built areas in an entity with own identity, structure and mode of operation

La estructura verde en el proceso de planificación urbana

Natural areas and urban green structure are essential parts of the urban tissues with which, in their different morphologies and central levels, cities are organized, built and operated. The presence of natural elements results of the implementation of various approaches to land management, or simply pragmatic decisions you resources management. The presence of natural elements in the urban landscape allows low stress processes of urbanization and rehabilitation and regeneration and more respect to the environmental balance that contribute to urban sustainability. The open spaces system created by the presence of natural elements allows the existence of ecological corridors for biodiversity conservation, land and building structure and urban green areas organization. What means that to organize urban expansion or requalification is above all to integrate nature and built areas in an entity with own identity, structure and mode of operation.Los espacios naturales y la estructura verde urbana son partes esenciales de los tejidos con los cuales, en sus diferentes morfologías y niveles de centralidad, las ciudades se organizan, construyen y funcionan. La presencia de elementos naturales resulta de la aplicación de diversos criterios de ordenación de territorial o, simplemente, de decisiones pragmáticas de gestión de os recursos. La presencia de elementos naturales en el paisaje urbano permite que los procesos de urbanización y de rehabilitación y regeneración de los tejidos urbanos consolidados ocurran con bajo nivel de estrés y más respeto de los equilibrios ambientales que contribuyen a la sostenibilidad urbana. El sistema de espacios abiertos creado por la presencia de elementos naturales permite la existencia de corredores ecológicos para la conservación de la biodiversidad territorial y la creación y organización de la estructura verde urbana. Lo que significa que organizar la expansión o la recalificación de las ciudades es más que todo integrar el natural y el construido en una entidad con identidad, estructura y modo de funcionamiento propio

A PRODUÇÃO DO CUIDADO ÀS PESSOAS COM HANSENÍASE: UM OLHAR SOBRE A RESOLUBILIDADE DOS SERVIÇOS DE SAÚDE

A produção do cuidado em saúde é vista como sistêmica e integrada aos demais níveis da assistência, através da utilização de todos os recursos disponíveis para a construção de um Projeto Terapêutico Singular (PTS) que atenda às necessidades da população (Merhy; Franco,2005). Nesse contexto, a hanseníase é uma doença crônica, infectocontagiosa de evolução lenta, causada pelo Mycobacterium leprae, parasita que apresenta alta infectividade e baixa patogenicidade, e afeta primariamente os nervos periféricos e a pele, podendo causar sériasincapacidades físicas (ASSIS; JESUS, 2012). Já a resolubilidade é considerada como sendo uma resposta às demandas de acordo com as necessidades individuais e coletiva, garantindo ao usuário o acesso integral aos serviços de saúde (Santos; Assis, 2006). Essa pesquisa sejustifica pelas lacunas de conhecimento sobre a temática, bem como a importância social do estudo da resolubilidade na produção do cuidado das pessoas com hanseníase, identificando as ações desenvolvidas de forma centralizada, na unidade de referência. Diante disso, este estudo tem como questão norteadora: como ocorre a resolubilidade na produção do cuidado das pessoas com hanseníase no município de Feira de Santana- BA?Para responder tal questão, o estudo baseia-se no seguinte objetivo geral: analisar a resolubilidade na produção do cuidado executado pelo serviço de saúde às pessoas com diagnóstico de Hanseníase no município Feira de Santana-BA, além de ter como objetivos específicos: descrever as ações da equipe multidisciplinar no serviço de referência frente às demandas das pessoas com Hanseníase, em Feira de Santana-BA; compreender as facilidades e dificuldades para a resolubilidade na produção do cuidado das pessoas com Hanseníase, no serviço de referência, em Feira de Santana-BA

O impacto das TIC no mercado parisiense de arrendamento a turistas

Mestrado em Línguas e Relações EmpresariaisAs novas tecnologias invadiram o dia-a-dia das pessoas, em especial depois da última metade dos anos 90 com a disseminação da internet. Também no mundo dos negócios têm sido utilizadas cada vez mais, no sentido de melhorar não apenas a qualidade da comunicação, mas também a produtividade e o lucro. Infiltraram-se no quotidiano empresarial de tal modo que empresas como a Habitat Parisien são já completamente dependentes de softwares avançados e smartphones, estabelecendo até o seu marketing unicamente na internet. A influência dessas ferramentas vai aqui ser analisada num caso concreto de uma empresa de arrendamento para turismo na cidade de Paris.New technologies have been invading people’s daily life, mostly after the 90’s second half, with the dissemination of internet. Also in the business world, they have been used more and more, in order to improve, not only the quality of communication, but also productivity and profit. They got in the business daily life in such a way that companies like Habitat Parisien are now completely dependent on advanced software and smartphones, having even their marketing only by internet. The influence of these tools will be analyzed in this paper, using a case study of a tourism rental agency in the city of Paris.Les nouvelles technologies ont invahi le quotidien des gens, surtout après la dernière moitié des années 90, avec la dissémination de l’internet. Elles sont aussi utilisées de plus en plus dans le monde des affaires, en essayant d’améliorer la qualité de la communication et aussi la productivité et les revenus. Ces technologies sont à tel point entrées dans les activités commerciales que des entreprises comme Habitat Parisien dépendent, à un niveau très élevé, des softwares avancés et d’outils comme les Smartphones, ayant localisé toutes leurs activités de marketing, à l’exclusivité, sur internet. L’influence de ces instruments sera analysée dans les prochaines pages, ayant comme exemple le cas d’une agence de location saisonnière à Paris