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The study aimed to determine the influence of financial behavior on household’s financial stress in Tagum City, Davao del Norte. This study utilized a quantitative non-experimental, descriptive type of research with 150 respondents selected through purposive sampling technique. Mean was the statistical tool used for the data treatment. Results showed a high financial behavior level and a moderate financial stress level among households in Tagum City. For the students to lowe, {"references":["Abdelkhalek J., Bradley U. & Mitchell O., (2010).Financial literacy and retirement planning: New evidence from the Rand American Life Panel. CFS Working Paper. DOI: 10.2139/ssrn.1095869","Attanasio, O. & Brugiavini, A., (2003). Social Security and Households' Saving. Quarterly Journal of Economics. DOI: 10.1162/00335530360698504","Bandura A., (1982). Self-efficacy mechanism in human agency, American Psychologist.37,122-147. DOI: 10.1037/0003-066X.37.2.122.","Belli, G. (2011).Nonexperimental quantitative research based on Educational Research: Quantitative, Qualitative, and Mixed Applications. DOI 10.4236/ijmnta.2016.51003","Conger, R. D., Conger, K. J., & Martin, M. J. (2010). Socioeconomic status, family processes, and individual development. Journal of Marriage and Family, 72(3), 685-704. https://doi.org/10.1111/j.1741-3737.2010.00725.x","Cox H., Drew H. & Walter L., (2010).The effects of financial behaviours on the quality of family life: Evidence from adolescent perceptions. In proceedings of the Association for Financial Counselling and Planning Education, Symposium conducted at the 19th Annual Association for Financial Counselling and Planning Education Conference, Orlando","Dodo, M. (2020). Understanding Africa's Food Security Challenges. \"British Journal. DOI: 10.5772/intechopen.91773.","Ebissa, T., & Kassie, G., (2015)., Determinats of Households Saving Behavior: Case of East Gojjan Zone, Ethiopia. International Journal of Research in Finance and Marketing, Vol 7(2), 93-102. https://euroasiapub.org/current.php?title=IJRFM."]}

Sheep is one of the livestock commodities that is developed and utilized by farmer to meet the increasing demand of animal protein. This study aimed to investigate physiological responses of local sheep that were kept on different raising system and given different type concentrate. The study used 24 heads of local sheep with an average initial live weight of 19.79±2.47kg. The experiment was set up in a completely randomized design with two factors. The first factor was rearing system (intensive and semi intensive) and second factor was type of concentrate feed (green and comercial concentrates). The parameters observed were heart rate, rectal temperature, respiration rate, differential leukocytes N/L and cortisol hormone levels. The data were analyzed by repeated mensure analysis of variance (repeted ANOVA). The results showed that the type of concentrate did not affect blood profile and cortisol hormone levels. Sheep’s physiological response (respiration rate, heart rate and rectal temperature) were significantly (P0

Objectives. The Association of Philippine Medical Colleges (APMC) responded to the global call for transformative learning by conducting a series of Faculty In-service Training. This study was commissioned to determine faculty trainees' perceptions of the program in terms of relevance, comprehensiveness, and quality. It also described their applications of the program in their delivery of instruction, assessment, organization, and management skills. Methods. This is a sequential explanatory mixed-method research. The quantitative phase refers to the analysis of the rating scale accomplished by participants as feedback. The qualitative phase includes analysis of focus group discussion results and actual course syllabi used by selected participants, including medical schools' documents. Both data were integrated using a combination of descriptive statistics, measures of central tendency and dispersion, as well as joint displays. Results. APMC conducted six in-service trainings from 2015 to 2018. Themes focused on medical teachers' roles as instructional designers, facilitators, assessors of learning, and as leaders and managers. Respondents perceived the programs as most relevant, comprehensive, and interesting. The syllabi, instructional resources, and assessment instruments and practices were consistent with the standards of the Commission on Higher Education. Medical teachers showed that they use innovative teaching and assessment strategies, and are dealing with medical education's continuous challenges. Conclusion. Faculty participants perceived the APMC in-service training programs most favorably for capacitating them to enhance their teaching skills and inculcate the culture of quality in medical schools. APMC's training also reflects the organization's commitment to social accountability.

Objective: Despite evidence of a relationship between obstructive sleep apnea (OSA), metabolic dysregulation and diabetes mellitus (DM), it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and DM risk in patients with cardiovascular disease (CVD) and OSA. Research Design and Methods: Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea Cardiovascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus Usual Care, or Usual Care alone. Serum glucose and glycated hemoglobin A1c (HbA1c) were measured at baseline, and six months, two- and four years, and incident diabetes diagnoses recorded. Results: Median follow-up was 4.3 years. In those with pre-existing DM (n=274), there was no significant difference between CPAP and Usual Care groups in serum glucose, HbA1c or anti-diabetic medications during follow-up. There were also no significant between-group differences in participants with pre-diabetes (n=452), nor in new diagnoses of DM. Interaction testing suggested that women with diabetes did poorly in the Usual Care group while their counterparts on CPAP therapy remained stable. Conclusions: Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affected glycemic control in those with diabetes or pre-diabetes, or DM risk over standard of care treatment. The potential differential effect according to sex deserves further investigation.

Obstructive sleep apnoea (OSA) is the main secondary form associated with resistant hypertension (RH), but it is largely underdiagnosed and consequently undertreated in clinical practice. The Berlin questionnaire (BQ) is a useful tool among general population, but seems to not perform well among patients with RH. Recently, NoSAS score was validated in a large population, however, has not been tested in the cardiovascular scenario. Thus, we aimed to compare BQ versus the NoSAS score as screening tools for OSA in RH. In the present study, patients with confirmed diagnosis of RH were invited to perform polysomnography. OSA was diagnosed by an apnoea-hypopnoea index (AHI) ≥15 events/h. BQ and NoSAS were applied in a blinded way. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) of the two sleep questionnaires to detect OSA in RH. The frequency of OSA was 64%. The BQ presented a better sensitivity (91 vs. 72%) and higher values of NPV (67 vs. 54%) than NoSAS score. In contrast, the NoSAS score had higher specificity for excluding OSA (58 vs. 33%) and higher PPV (75 vs. 70%). Compared to the BQ, NoSAS score had a better AUC (0.55 vs. 0.64) but these values are in the fail to poor accuracy range. In conclusion, both BQ and NoSAS score had low accuracy for detecting OSA in RH. Considering the high frequency of OSA, objective sleep study may be considered in these patients.

In this study, the notion of $AB$-homomorphism of an $AB$-algebra is introduced and some of its properties are obtained. Moreover, the first and third isomorphism theorems for $AB$-algebras are investigated.

Utilizing data from an eHarmony.com relationship questionnaire completed by new users (N = 5,434), this study identifies prioritized goals in new romantic relationships and whether importance of these goals differs by participants’ age and gender. Overall, users valued interpersonal communication more than sex appeal. Older users rated sexual attraction as slightly less important than younger users did, but they still highly valued the goal. Women placed even greater emphasis on communication over sexual attraction compared to men. However, although men valued sexual attraction more than women at all ages, only the youngest women valued interpersonal communication more than young men.

In this work we consider a region S ⊂ given by a finite number of nonlinear smooth convex inequalities and having nonempty interior. We assume a point x 0 is given, which is close in certain norm to the analytic center of S, and that a new nonlinear smooth convex inequality is added to those defining S (perturbed region). It is constructively shown how to obtain a shift of the right-hand side of this inequality such that the point x 0 is still close (in the same norm) to the analytic center of this shifted region. Starting from this point and using the theoretical results shown, we develop a heuristic that allows us to obtain the approximate analytic center of the perturbed region. Then, we present a procedure to solve the problem of nonlinear feasibility. The procedure was implemented and we performed some numerical tests for the quadratic (random) case.

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial (hypopnea) or complete interruption (apnea) in breathing during sleep due to airway collapse in the pharyngeal region. OSA and its cardiovascular consequences have been widely explored in observational and prospective studies. Most evidence verifies the positive relationship between OSA and hypertension, coronary artery disease, atrial fibrillation, stroke and heart failure. However, more studies are needed to better assess the impact of OSA, and possible benefit of treatment with continuous positive airway pressure (CPAP) on dyslipidemia, type 2 diabetes, insulin resistance and cardiovascular mortality. The leading pathophysiological mechanisms involved in the changes triggered by OSA, include intermittent hypoxemia and re-oxygenation, arousals and changes in intrathoracic pressure. Hypertension is strongly related with activation of the sympathetic nervous system, stimulation of the renin-angiotensin-aldosterone system and impairment of endothelial function. The high prevalence of OSA in the general population, hypertensive patients and especially obese individuals and patients resistant to antihypertensive therapy, highlights the need for effective screening, diagnosis and treatment of OSA to decrease cardiovascular risk.

This is a short tutorial on complexity studies for differentiable convex optimization. A complexity study is made for a class of problems, an "oracle" that obtains information about the problem at a given point, and a stopping rule for algorithms. These three items compose a scheme, for which we study the performance of algorithms and problem complexity. Our problem classes will be quadratic minimization and convex minimization in ℝn. The oracle will always be first order. We study the performance of steepest descent and Krylov spacemethods for quadratic function minimization and Nesterov’s approach to the minimization of differentiable convex functions.

High cell density cultivations of recombinant E. coli have been increasingly used for the production of heterologous proteins. However, it is a challenge to maintain these cultivations within the desired condi- tions, given that some variables such as dissolved oxygen concentration (DOC) and feed flow rate are difficult to control. This paper describes the software SUPERSYS_HCDC, a tool developed to supervise fed-batch cultures of rE. coli with biomass concentrations up to 150 gDCW/L and cell productivities up to 9 gDCW.L -1 .h -1 . The tool includes automatic control of the DOC by integrated action of the stirrer speed as well as of the air and oxygen flow rates; automatic start-up of the feed flow of fresh medium (system based on a neural network committee); and automatic slowdown of feeding when oxygen consumption exceeds the maximum capacity of the oxygen supply.

We consider the minimization of a convex function on a bounded polyhedron (polytope) represented by linear equality constraints and non-negative variables. We define the Levenberg---Marquardt and central trajectories starting at the analytic center using the same parameter, and show that they satisfy a primal-dual relationship, being close to each other for large values of the parameter. Based on this, we develop an algorithm that starts computing primal-dual feasible points on the Levenberg---Marquardt trajectory and eventually moves to the central path. Our main theorem is particularly relevant in quadratic programming, where points on the primal-dual Levenberg---Marquardt trajectory can be calculated by means of a system of linear equations. We present some computational tests related to box constrained trust region subproblems.

We describe two algorithms for solving differentiable convex optimization problems constrained to simple sets in $\mathbb{R}^n $, i.e., sets on which it is easy to project an arbitrary point. The algorithms are optimal in the sense that they achieve an absolute precision of $ \varepsilon $ in relation to the optimal value in $ O(1/\sqrt\varepsilon) $ iterations using only first-order information. This complexity depends on an (unknown) Lipschitz constant $ L^* $ for the function derivatives and on a (known) strong convexity constant $ \mu^*\geq 0 $. The algorithms are extensions of well-known methods devised by Nesterov [Introductory Lectures on Convex Optimization, Kluwer Academic, Boston, 2004], without the need for estimates of $ L^* $ and including (in the second algorithm) line searches and an adaptive procedure for estimating a strong convexity constant. The algorithms are such that all computed points are feasible, and the complexity analysis follows a simple geometric approach. Numerical tests for...

Obstructive sleep apnea (OSA) and hypertension are both independently associated with increased cardiovascular risk.1–7 Furthermore, approximately 50% of patients with OSA have a diagnosis of hypertension, whereas 30% of hypertensive patients have OSA.8–11 Recently published evidence-based hypertension management guidelines identified OSA as an important identifiable cause of hypertension.12 The association of OSA and hypertension is particularly marked among patients with resistant hypertension, with studies reporting an OSA prevalence of 80% to 85% in these patients.13,14 BRIEF SUMMARY Current Knowledge/Study Rationale: We previously described a significant correlation between plasma aldosterone concentration and severity of obstructive sleep apnea in patients with resistant hypertension. This investigation examines the relationship between aldosterone status and obstructive sleep apnea in patients with resistant hypertensive—with and without hyperaldosteronism. Study Impact: The positive relationship between hyperaldosteronism and severity of obstructive sleep apnea (OSA) observed in the current analysis supports the hypothesis that aldosterone excess contributes to the development of OSA. The results highlight the increased likelihood of hyperaldosteronism and OSA coexisting in patients with resistant hypertension and may explain, at least in part, the high prevalence of OSA in patients with resistant hypertension. Hyperaldosteronism is common in patients with resistant hypertension. Approximately 20% of patients with resistant hypertension have biochemical criteria consistent with primary aldosteronism.15–18 In patients with resistant hypertension in whom we had diagnosed hyperaldosteronism, we observed that many had been previously diagnosed with OSA. We, therefore, hypothesized that the 2 diseases may be mechanistically related, that is one contributing to the other. Our center noted increased aldosterone excretion in patients with resistant hypertension who had symptoms of OSA.19 We then showed that a significant correlation exists between plasma aldosterone concentration (PAC) and OSA severity in patients with resistant hypertension but not in normotensive control subjects.14 Although we cannot directly infer causality from these studies, these results are consistent with the hypothesis that aldosterone excess may contribute to worsening severity of OSA. To gain further insight into the association among resistant hypertension, OSA, and hyperaldosteronism, we evaluated the relationship between aldosterone levels and OSA severity in patients with resistant hypertension with and without hyperaldosteronism.

Across human societies, people form long-term romantic bonds that can last a lifetime. Many theorists have proposed that the emotion love plays a causal role in maintaining these bonds, but no work to date has tested this hypothesis directly. In this study, we predicted that feeling love for a romantic partner would facilitate suppressing thoughts of attractive alternative mates. We used a relived emotion task to induce love or sexual desire for a romantic partner and asked participants to suppress thoughts of an attractive alternative. After suppression, participants in the love condition reported fewer thoughts of the attractive alternative and accurately recalled fewer attractiveness-related details about the alternative than those in the desire condition. Reports of love, but not sexual desire, predicted greater commitment to the current partner during the study. These results suggest that love serves a function distinct from desire and that love can operate as a commitment device.

Close relationship partners often share successes and triumphs with one another, but this experience is rarely the focus of empirical study. In this study, 79 dating couples completed measures of relationship well-being and then participated in videotaped interactions in which they took turns discussing recent positive and negative events. Disclosers rated how understood, validated, and cared for they felt in each discussion, and outside observers coded responders' behavior. Both self-report data and observational codes showed that 2 months later, responses to positive event discussions were more closely related to relationship well-being and break-up than were responses to negative event discussions. The results are discussed in terms of the recurrent, but often overlooked, role that positive emotional exchanges play in building relationship resources.

Este artigo aborda o problema de locação ótima de torres de transmissão como uma aplicação de métodos de busca em grafos com nós parcialmente ordenados com uma modelagem que aplica a este problema pela primeira vez o conceito de relações de preferência entre nós. São primeiramente apresentados resultados sobre grafos e algoritmos de busca. As restrições eletro-mecânicas e topográficas à obtenção do caminho de custo mínimo são descritas, são definidos os nós, arcos, custos, e caminhos, além de outros componentes do grafo e são descritos os algoritmos de otimização utilizados. O trabalho introduz e demonstra a validade de relações de preferência entre nós, que são utilizadas (juntamente com comparações de custos) no processo de eliminação de caminhos. Este procedimento aumenta a eficiência dos algoritmos de otimização utilizados.This paper focuses on optimal transmission tower spotting as an application of search methods in a graph with partially ordered nodes and for the first time models the problem using preference relations between nodes. First basic results from graph theory and search algorithms are presented. Electro-mechanical and topographical constraints to obtaining the path of minimum cost are described, the nodes, arcs, costs and paths are defined, and the optimization algorithms are shown. The paper introduces and demonstrates the validity of preference relations between nodes. These are used together with cost comparisons to eliminate paths. This procedure increases the efficiency of the optimization algorithms.

A acidez potencial tem grande importância pela sua utilização na determinação da saturação por bases e auxílio na recomendação da necessidade de calagem. Este estudo teve por objetivo avaliar a relação entre o teor de H + Al e o pH SMP, visando estabelecer uma equação para estimar a acidez potencial de solos da Região Norte de Minas Gerais. As análises dos teores de H + Al (acetato de cálcio 0,5 mol L-1 a pH 7,0) e dos valores de pH SMP foram realizadas no laboratório de fertilidade do solo da EPAMIG/CTNM em 50 amostras de solo, com valores de pH em água variando de 4,6 a 7,8, teores de carbono orgânico de 3 a 45 g kg-1 e os de argila de 80 a 610 g kg-1. A acidez potencial, expressa em cmol c dm-3, pode ser estimada pelo uso do pH SMP, utilizando para isso a seguinte equação: H + Al = 0,00359 + 1556,5806 e- pHSMP (R² = 0,96**). Potential acidity is of great importance for the base saturation determination and for the recommendation of liming. The objective of this study was to evaluate the relationship between pH SMP and H + Al contents, in order to establish an equation for the potential acidity estimation of soils from Northern Minas Gerais, Brazil. The H + Al concentration (0.5 mol L-1 calcium acetate pH 7.0) and pH SMP were analysed at EPAMIG/CTNM soil fertility laboratory, in 50 soil samples. The pH in water of the soil samples ranged from 4.6 to 7.8, organic carbon contents varied from 3 to 45 g kg-1 and clay contents from 80 to 610 g kg-1. The potential acidity, expressed in cmol c dm-3, can be estimated by measuring the pH SMP using the following equation: H + Al = 0.00359 + 1556.5806 e- pH SMP (R² = 0.96**)

The condition numbers described by Stewart, Todd, and others for a matrix A are given by the suprema of the norms of all the oblique projection operators respectively on the image space of A T and the null space of A . This paper shows that these two numbers coincide.

In this work we demonstrate that the Mizuno--Todd--Ye predictor-corrector primal-dual interior-point method for linear programming generates iteration sequences that converge to the analytic center of the solution set.

It is known that the Mizuno--Todd--Ye predictor-corrector primal-dual Newton interior-point method generates a duality-gap sequence which converges quadratically to zero, and this is accomplished with an iteration complexity of $O(\sqrt n L)$. Very recently, the present authors demonstrated that the iteration sequence generated by this method converges, and this convergence is to the analytic center of the solution set. In the current work we show that within a finite number of iterations, the Newton corrector step can be replaced with a simplified Newton corrector step, and the resulting algorithm maintains $O(\sqrt n L)$ iteration complexity, quadratic convergence of the duality-gap sequence to zero, and convergence of the iteration sequence (however, not necessarily to the analytic center). The simplified predictor-corrector algorithm requires only one linear solve per iteration in contrast to the two linear solves per iteration required by the original predictor-corrector algorithm.

Each master iteration of a simplified Newton algorithm for solving a system of equations starts by computing the Jacobian matrix and then uses this matrix in the computation ofp Newton steps: the first of these steps is exact, and the other are called "simplified". In this paper we apply this approach to a large step path following algorithm for monotone linear complementarity problems. The resulting method generates sequences of objective values (duality gaps) that converge to zero with Q-orderp+1 in the number of master iterations, and with a complexity of $$O(\sqrt n L)$$ iterations.

Arterial blood pressure (BP) is a very useful variable in clinical practice. Its measurement is simple, inexpensive and easy; it is worth noting that BP should be accurately obtained, following the recommendations of the VI Brazilian Guidelines on Hypertension (DBH VI)1. Office BP measurement is the central parameter for the diagnosis, treatment and follow-up of systemic arterial hypertension (SAH), being directly, continuously and independently related to the risk of fatal and non-fatal cardiovascular (CV) events1-3. Thus, the consideration of BP values closer to the upper limits of normality, the so-called prehypertension (PH)2, and intervention on those values have been emphasized over the last decade, because PH represents an important opportunity to prevent established SAH, contributing to reduce the associated CV risk. Repeated BP measurement at the office allows the diagnosis of hypertension and normotension. To better assess BP behavior, there are methods that analyze BP by using a higher number of measurements, minimizing interferences of the environment, situation and observer. Those alternatives are as follows: 24-hour ambulatory BP monitoring (ABPM); and dwelling BP measurement [home BP monitoring (HBPM) and BP self-measurement (BPSM)]. Based on those methods, two other BP classifications were adopted: white coat hypertension (WCH) and masked hypertension (MH)1,3-5 (Figure 1). Figure 1 Classification of blood pressure behavior considering office BP, ABPM and home BP measurements1. ABPM: ambulatory blood pressure monitoring; BP: blood pressure. Epidemiological and clinical studies on those conditions are still limited; however, they deserve attention because of their higher CV risk as compared with normotension6,7. This document represents the position of the Brazilian Society of Cardiology Arterial Hypertension Department (DHA/SBC) on the diagnosis and non-drug and drug therapy for PH, WCH and MH, aiming at contributing to a better clinical practice.

The literature on interior point algorithms shows impressive results related to the speed of convergence of the objective values, but very little is known about the convergence of the iterate sequences. This paper studies the horizontal linear complementarity problem, and derives general convergence properties for algorithms based on Newton iterations. This problem provides a simple and general framework for most existing primal-dual interior point methods. The conclusion is that most of the published algorithms of this kind generate convergent sequences. In many cases (whenever the convergence is not too fast in a certain sense), the sequences converge to the analytic center of the optimal face.

BACKGROUND: New recommendations on reference values for normal test results in ambulatory blood pressure monitoring (ABPM) were proposed by the V Brazilian Guidelines on Ambulatory Blood Pressure Monitoring, based mainly on the IDACO study. Objectives: This epidemiological study is aimed at evaluating the impact of adopting these new standards in an arterial hypertension referral center. METHODS: The results of 1,567 ABPM tests carried out between 2005 and 2010 were analyzed; 481 patients were excluded from the sample for not meeting minimum quality criteria of the test. Reference values from the IV Brazilian Guidelines on ABPM (2005) were used for the classification of these tests regarding the abnormality and compared with the changes proposed by the V Brazilian Guidelines on ABPM (2011). Statistical analysis was performed by Pearson's chi-square method and p values < 0.05 were considered statistically significant. RESULTS: For the 1,086 tests evaluated, there was a significant difference in the proportion of patients with altered ABPM results, especially for the variable systolic pressure in the sleeping period: 49% when adopting the cutoff values of 2005 and 71% when adopting the values of 2011, with statistical significance, p < 0.0001. CONCLUSIONS: The recommendations of the new guidelines had a great impact on the hypertension classification by ABPM test results in the study population. The question of thresholds of these tests for therapeutic targets of patients known to be hypertensive is still open and requires further studies, preferably national ones, for better definition of the subject.

Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. However, there are no studies systematically evaluating secondary causes of hypertension according to the Seventh Joint National Committee. Consecutive patients with resistant hypertension were investigated for known causes of hypertension irrespective of symptoms and signs, including aortic coarctation, Cushing syndrome, obstructive sleep apnea, drugs, pheochromocytoma, primary aldosteronism, renal parenchymal disease, renovascular hypertension, and thyroid disorders. Among 125 patients (age: 52±1 years, 43% males, systolic and diastolic blood pressure: 176±31 and 107±19 mm Hg, respectively), obstructive sleep apnea (apnea-hypopnea index: >15 events per hour) was the most common condition associated with resistant hypertension (64.0%), followed by primary aldosteronism (5.6%), renal artery stenosis (2.4%), renal parenchymal disease (1.6%), oral contraceptives (1.6%), and thyroid disorders (0.8%). In 34.4%, no secondary cause of hypertension was identified (primary hypertension). Two concomitant secondary causes of hypertension were found in 6.4% of patients. Age >50 years (odds ratio: 5.2 [95% CI: 1.9–14.2]; P P =0.02), and presence of snoring (odds ratio: 3.7 [95% CI: 1.3–11]; P =0.02) were predictors of obstructive sleep apnea. In conclusion, obstructive sleep apnea appears to be the most common condition associated with resistant hypertension. Age >50 years, large neck circumference measurement, and snoring are good predictors of obstructive sleep apnea in this population.

In this paper a unified treatment of algorithms is described for linear programming methods based on the central path. This path is a curve along which the cost decreases, and that stays always far...

Obstructive sleep apnea (OSA) is a secondary cause of hypertension and independently associated with target-organ damage in hypertensive patients. However, OSA remains largely underdiagnosed and undertreated. The aim of the present study was to evaluate the characteristics and clinical predictors of OSA in a consecutive series of patients followed up in a hypertension unit. A total of 99 patients (age 46 + or - 11 years, body mass index 28.8 kg/m(2), range 25.1 to 32.9) underwent polysomnography. The clinical parameters included age, gender, obesity, daytime sleepiness, snoring, Berlin Questionnaire, resistant hypertension, and metabolic syndrome. Of the 99 patients, 55 (56%) had OSA (apnea-hypopnea index5 events/hour). Patients with OSA were older and more obese, had greater levels of blood pressure, and presented with more diabetes, dyslipidemia, resistant hypertension, and metabolic syndrome than the patients without OSA. Of the patients with OSA, 51% had no excessive daytime sleepiness. The Berlin Questionnaire and patient age revealed a high sensitivity (0.93 and 0.91, respectively) but low specificity (0.59 and 0.48, respectively), and obesity and resistant hypertension revealed a low sensitivity (0.58 and 0.44, respectively) but high specificity (0.75 and 0.91, respectively) for OSA. Metabolic syndrome was associated with high sensitivity and specificity for OSA (0.86 and 0.85, respectively). Multiple regression analysis showed that age of 40 to 70 years (odds ratio 1.09, 95% confidence interval 1.03 to 1.16), a high risk of OSA on the Berlin Questionnaire (odds ratio 8.36, 95% confidence interval 1.67 to 41.85), and metabolic syndrome (odds ratio 19.04, 95% confidence interval 5.25 to 69.03) were independent variables associated with OSA. In conclusion, more important than the typical clinical features that characterize OSA, including snoring and excessive daytime sleepiness, the presence of the metabolic syndrome is as an important marker of OSA among patients with hypertension.

Background: Obstructive sleep apnea (OSA) and hyperaldosteronism are common in subjects with resistant hypertension. Prior results from our laboratory relate severity of OSA to aldosterone levels in patients with resistant hypertension suggesting that the 2 disease entities may be mechanistically linked. Objective: This study prospectively evaluated the relation between OSA severity and aldosterone status in subjects with resistant hypertension. Methods: One hundred nine consecutive subjects (age 55.9±9.3 years; 50% male) with resistant hypertension referred to a university clinic for resistant hypertension were prospectively evaluated with plasma renin activity (PRA), plasma aldosterone concentration, and 24-hr urinary aldosterone excretion. Hyperaldosteronism was defined as a PRA Results : Hyperaldosteronism was present in 28% of subjects. Overall, OSA was diagnosed in 77% of subjects; 81% of the high-aldosterone and 74% of the normal-aldosterone subjects. In subjects with hyperaldosteronism, plasma aldosterone and urinary aldosterone excretion correlated with AHI (r = 0.723, p Conclusion: OSA is extraordinarily common in patients with resistant hypertension. A significant correlation between both plasma and urinary aldosterone levels and severity of OSA is observed in high-aldosterone but not normal-aldosterone subjects. The higher level of ANP in high-compared to normal-aldosterone subjects suggests greater intravascular fluid retention in the former subjects. These results suggest worsening of OSA in patients with hyperaldosteronism secondary to chronic aldosterone-induced intravascular fluid retention.

This paper presents some examples of ill-behaved central paths in convex optimization. Some contain infinitely many fixed length central segments; others manifest oscillations with infinite variation. These central paths can be encountered even for infinitely differentiable data.

Cardiovascular disease is one of the major causes of death worldwide. Among its risk factors, obstructive sleep apnea (OSA) is a common but still underestimated condition. OSA often coexists and interacts with obesity, sharing multiple pathophysiological mechanisms and subsequent cardiovascular risk factors, such as type 2 diabetes, dyslipidemia, systemic inflam - mation, and in particular hypertension. There is also evidence suggesting an increased risk of arrhythmia, heart failure, renal failure, acute myocardial infarction, stroke, and death. OSA is characterized by recurrent episodes of partial (hypopnea) or complete interruption (apnea) of breathing during sleep due to airway collapse in the pharyngeal region. The main mechanisms linking OSA to impaired cardiovascular function are secondary to hypoxemia and reoxygenation, arousals, and negative intrathoracic pressure. Consequently, the sympathetic nervous and the renin-angiotensin-aldosterone systems may be overestimulated, and blood pressure increased. Resistance to treatment for hypertension represents a growing issue, and given that OSA has been recognized as the major secondary cause of resistant hypertension, clinical investigation for apnea is mandatory in this population. Standard diagnosis includes polysomnography, and treatment for OSA should include control of risk factors for cardiovascular disease, including obesity. So far, continuous positive airway pressure is the treatment of choice for OSA, impacting positively on blood pressure goals; however, the impact on long-term follow-up and on cardio- vascular disease should be better assessed.

Introduction There is growing literature regarding the controversial subject of the placement of early intervention in psychosis programs (EIP) in the psychiatric services network. Objectives/ Aim To review the literature concerning the different organizational models in early intervention in psychosis and their positioning with local psychiatric services. To describe our community based early intervention program, integrated in a general adult psychiatry service. We intend to reflect about our experience, on the weaknesses and strengths of our service's model. Methods A non-systematic literature review about different models of service organization in early intervention in psychosis was performed, using Medline database and Google Scholar search-engine as well as reference textbooks. Results The current debate is centered on whether EIP should be organized as autonomous services or integrated in broader psychiatric services. The PSIC Programme is an assertive community-based programme for patients with a first psychotic episode. It was developed by the Psychiatric Department of Prof. Doutor Fernando Fonseca Hospital in 2001 through the cooperative use of the existing human and financial resources. Conclusions The integration of early intervention programs in general psychiatric services, allows for the delivery of specialized rehabilitative treatments while maintaining the continuity of care even after the critical period. Early intervention programs encapsulate a new optimism within community mental health teams. Inevitably the high standards imported from early intervention, begin to be benchmarks for all services for psychotic individuals.