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Introduction: Post-traumatic headache (PTH), a common type of headache secondary to traumatic brain injury (TBI) or whiplash, carries a relevant burden on patients. PTH is still an undertreated condition because of limited pharmacological treatment options. Therefore, multimodal non-pharmacologic approaches, which account for comorbidities and biopsychosocial factors, are often used in PTH patients. Areas covered: After providing a brief overview of PTH, a systematic review was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations on recently published (2015–2020) papers on non-pharmacological interventions for PTH. We also collected data on ongoing trials on this topic. Studies and results are reviewed and discussed. Expert opinion: PTH is one of the most common complications of TBI and accounts for almost 4% of symptomatic headache disorders. The most common clinical presentations of PTH are migraine-like or tension type (TTH)-like headache, neck pain, cognitive complaints, and psychological/psychiatric symptoms. Growing evidence suggests that combined pharmacological and non-pharmacological interventions, encompassing noninvasive neuromodulation, physical therapy, cognitive-behavioral treatment, and education, may be the best approaches for PTH and related comorbidities. Acute/preemptive pharmacological treatments for PTH include drugs used for migraine and TTH. When PTH management is multidisciplinary, the patient benefits most. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

The planetary boundaries concept has profoundly changed the vocabulary and representation of global environmental issues. We bring a critical social science perspective to this framework through the notion of societal boundaries and aim to provide a more nuanced understanding of the social nature of thresholds. We start by highlighting the strengths and weaknesses of planetary boundaries from a social science perspective. We then focus on capitalist societies as a heuristic for discussing the expansionary dynamics, power relations, and lock-ins of modern societies that impel highly unsustainable societal relations with nature. While formulating societal boundaries implies a controversial process ‒ based on normative judgments, ethical concerns, and socio-political struggles ‒ it has the potential to offer guidelines for a just, social-ecological transformation. Collective autonomy and the politics of self-limitation are key elements of societal boundaries and are linked to important proposals and pluriverse experiences to integrate well-being and boundaries. The role of the state and propositions for radical alternative approaches to well-being have particular importance. We conclude with reflections on social freedom, defined as the right not to live at others’ expense. Toward the aim of defining boundaries through transdisciplinary and democratic processes, we seek to open a dialogue on these issues. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Introduction: Botulinum neurotoxin type-A (BoNTA) is licensed for the treatment of chronic migraine (CM), but it has been tested off-label as a therapeutic choice in other primary headaches (PHs). We aimed to provide a systematic review and expert opinion on BoNTA use in PHs, beyond CM. Areas covered: After providing an overview on PHs and mechanism of BoNTA action, we report the results of a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of BoNTA therapeutic trials in PHs beyond CM. Studies and results were reviewed and discussed, and levels of evidence were graded. We also collected data on relevant ongoing trials. Expert opinion: Although there are contradictory findings on PHs other than CM, BoNTA may represent a therapeutic option for patients who do not respond to conventional prophylactic treatments. Based on limited available evidence, BoNTA may be considered in refractory tension-type headache, trigeminal autonomic cephalalgias, primary stabbing headache, nummular headache, hypnic headache, and new daily persistent headache, after the primary nature of cephalalgia has been documented and other drugs have failed. Experienced physicians in BoNTA treatment are required to guide the therapeutic protocol for each patient to optimize good and safe outcomes. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

Objective\ud Pregnancies complicated by fetal growth restriction (FGR) have a worse outcome than those with a small‐for‐gestational‐age (SGA) fetus. There is increasing evidence of a maternal cardiovascular role in the pathophysiology of FGR. We aimed to compare maternal hemodynamic indices between pregnancies complicated by FGR and those delivering a SGA neonate, using a non‐invasive device.\ud \ud Methods\ud This was a prospective study of normotensive pregnancies complicated by FGR (defined as estimated fetal weight (EFW)

OBJECTIVE: Selective fetal growth restriction (sFGR) occurs in monochorionic twin pregnancies when unequal placental sharing leads to restriction in the growth of just one twin. Management options include laser separation of the fetal circulations, selective reduction or expectant management, but what constitutes the best treatment is not yet known. New trials in this area are urgently needed but, in this rare and complex group, maximizing the relevance and utility of clinical research design and outputs is paramount. A core outcome set ensures standardized outcome collection and reporting in future research. The objective of this study was to develop a core outcome set for studies evaluating treatments for sFGR in monochorionic twins. METHODS: An international steering group of clinicians, researchers and patients with experience of sFGR was established to oversee the process of development of a core outcome set for studies investigating the management of sFGR. Outcomes reported in the literature were identified through a systematic review and informed the design of a three-round Delphi survey. Clinicians, researchers, and patients and family representatives participated in the survey. Outcomes were scored on a Likert scale from 1 (limited importance for making a decision) to 9 (critical for making a decision). Consensus was defined a priori as a Likert score of ≥ 8 in the third round of the Delphi survey. Participants were then invited to take part in an international meeting of stakeholders in which the modified nominal group technique was used to consider the consensus outcomes and agree on a final core outcome set. RESULTS: Ninety-six outcomes were identified from 39 studies in the systematic review. One hundred and three participants from 23 countries completed the first round of the Delphi survey, of whom 88 completed all three rounds. Twenty-nine outcomes met the a priori criteria for consensus and, along with six additional outcomes, were prioritized in a consensus development meeting, using the modified nominal group technique. Twenty-five stakeholders participated in this meeting, including researchers (n = 3), fetal medicine specialists (n = 3), obstetricians (n = 2), neonatologists (n = 3), midwives (n = 4), parents and family members (n = 6), patient group representatives (n = 3), and a sonographer. Eleven core outcomes were agreed upon. These were live birth, gestational age at birth, birth weight, intertwin birth-weight discordance, death of surviving twin after death of cotwin, loss during pregnancy or before final hospital discharge, parental stress, procedure-related adverse maternal outcome, length of neonatal stay in hospital, neurological abnormality on postnatal imaging and childhood disability. CONCLUSIONS: This core outcome set for studies investigating the management of sFGR represents the consensus of a large and diverse group of international collaborators. Use of these outcomes in future trials should help to increase the clinical relevance of research on this condition. Consensus agreement on core outcome definitions and measures is now required. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:55 issue:5 pages:652-660 ispartof: location:England status: published

Objective\ud Pregnancies affected by a hypertensive disorder (HDP) have increased uterine artery pulsatility index (UtA‐PI) compared with that in healthy pregnancies. Women with HDP are also known to have lower cardiac output and increased systemic vascular resistance. The aim of this study was to investigate the relationship between central and uterine hemodynamics in HDP and uncomplicated pregnancy.\ud \ud Methods\ud This was a prospective study of HDP and normotensive control singleton pregnancies presenting at a tertiary referral hospital between January 2012 and December 2017. Paired measurements of maternal hemodynamics, using a non‐invasive device (USCOM‐1A®), and UtA‐PI were performed in the third trimester. HDP pregnancies were divided into preterm (onset 0.05), while systemic vascular resistance was significantly higher (median (IQR), 1315 (1099–1527) vs 1063 (915–1222) dynes × s/cm5; P

Brazil is known worldwide as one of the major producers of grain, meat, sugar, coffee and other products. Agribusiness is one of the main activities in Brazil and contributes significantly to the Brazilian economy. This fact led to even greater investments and developments in the market of agricultural machinery and implements in the country. From the 1960s to the end of 2018, land areas with agricultural potentia1 increased substantially, while the total number of wheel tractor fleets increased six-fold; in other words, the mechanized area in hectares per tractor decreased from 410 to 65 ha/tractor. The machinery Pedro Estevão Bastos de Oliveira President Chamber of Agricultural Machinery and Implements (CSMIA) ABIMAQ pedro@jacto.com.br BRAZIL André LuísTeixeira Fernandes President Brazilian Society of Agriculture Engineering - SBEA andreJernandes@uniube.br BRAZIL and equipment manufactures in the country today is sufficient to support a high-level mechanization process and to decrease the number of tractors/seed planters/combines and other types of equipment per hectare. The acquisition and modernization of tractors, harvesters and other equipment types depend on the income of farmers and governmental and private credit policies. The sales of agricultural machinery in Brazil are strongly influenced by the prices of international commodities such as soybean, maize, citrus and coffee. With excessive urbanization and fewer labor resources available, extensive and highly mechanized crop systems, such as soybean, sugar cane, rice and corn, have been established to attend to farm chronograms at different levels of technology. In addition to a large machinery production capacity, the Brazilian industry has also invested in advanced technology, mainly in tractors and combines, to save time and fuel, lower the level of fatigue and reduce cost. Made available in DSpace on 2019-07-06T01:05:08Z (GMT). No. of bitstreams: 1 Currentstatus.pdf: 8759545 bytes, checksum: 110e4f576797be7e777a91404b209c9e (MD5) Previous issue date: 2019

Objectives\ud \ud The main aim of this study was to construct reference ranges of maternal central hemodynamic parameters during pregnancy. The second aim was to determine the maternal and pregnancy characteristics that influence these hemodynamic parameters.\ud \ud Methods\ud \ud This was a prospective cohort study of low‐risk pregnant women attending for routine antenatal care at St George's Hospital, London, UK. Exclusion criteria included any medical disorder present at the time of study recruitment, or development of hypertension or intrauterine fetal growth restriction following study recruitment. Stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) were obtained using non‐invasive cardiac output monitoring (USCOM‐1A®). USCOM‐1A utilizes a non‐imaging probe in the suprasternal notch to obtain velocity‐time integrals of transaortic blood flow at the left ventricular outflow tract. Once the distribution of the data with respect to gestational age had been determined, maternal characteristics were added to the model to test whether they provided a significant improvement in the prediction of the median value.\ud \ud Results\ud \ud The study included 627 women with a singleton pregnancy. The estimated median CO was constant for a maternal age above 32 years, but was around 0.5 L/min higher for women aged ≤ 25 years (P

A utilização de tratores e implementos agrícolas é amplamente difundida em todos os tipos de cultura, atendendo às necessidades das diferentes escalas de produção das propriedades rurais. Um dos principais desafios inerentes ao uso desse tipo de equipamento é a dificuldade de aperfeiçoar seu emprego, estabelecendo-se condições de operação, que propiciem o equilíbrio entre a alta capacidade de trabalho que a mecanização agrícola proporciona, o consumo adequado de energia e a sustentabilidade da área de produção. Este trabalho descreve as etapas de implementação de um sistema de aquisição de dados e visa avaliar o desempenho energético de um conjunto tratorimplemento, utilizando um computador de placa única baseado na arquitetura ARM e sensores diversos. Algoritmos foram escritos em linguagem de programação C++ a fim de obter os sinais provenientes de cada um dos sensores e trata-los conforme sua natureza e grandeza física a ser mensurada. Após a etapa de programação, os sensores foram individualmente testados e calibrados em bancada e, posteriormente, o sistema como um todo foi testado no conjunto trator-implemento. O sistema mostrou-se uma ferramenta válida para auxiliar na tomada de decisão em operações de campo envolvendo máquinas agrícolas. Made available in DSpace on 2018-09-29T00:38:06Z (GMT). No. of bitstreams: 1 Usolinhagem.pdf: 829308 bytes, checksum: 8443e79ad807e6fb8b5077ac69de216c (MD5) Previous issue date: 2018-09-28

AIM: Maternal obesity is associated with significant pregnancy complications and is a risk factor for the development of hypertensive disorders of pregnancy as well as other adverse outcomes. There are few data regarding the hemodynamic aberrations observed in maternal obesity. The aim of this study was to investigate maternal hemodynamics in morbidly obese pregnant women. METHODS: This was a prospective, case-control study of morbidly obese women (BMI >40 kg/m(2) ) and controls (BMI 20-29.9 kg/m(2) ) at a ratio of one-to-ten. The control population was matched for maternal age and gestational age. BMI was calculated based on maternal height and weight at the time of recruitment to the study, which occurred on the same day as the hemodynamic assessment. Pregnant women in the second or third trimester of pregnancy were included. Women who were found to be hypertensive at any time were excluded from the study. USCOM-1A(®) was used to assess hemodynamic parameters (heart rate, stroke volume, cardiac output and systemic vascular resistance). The parameters were corrected for body surface area (BSA) to provide the stroke volume index (SVI), cardiac index (CI) and systemic vascular resistance index (SVRI). Mann Whitney-U test was used to compare the medians of the hemodynamic variables between the two groups. RESULTS: A total of 30 obese women and 327 controls were recruited. There was no difference in maternal (p = 0.506) or gestational (p = 0.693) age at recruitment between the groups. Mean arterial pressure was higher both at pregnancy booking (90 vs 80 mmHg, p

ObjectiveThe aim of this study was to determine whether glutamic acid decarboxylase antibody (GADA) titer and other clinical parameters could define the risk of progression to insulin therapy in latent autoimmune diabetes in adults (LADA) patients during a 7-year follow-up.MethodsThis study involved 220 LADA and 430 type 2 diabetes subjects followed up for 7 years from the time of GADA screening to evaluate their progression toward insulin therapy. Kaplan–Meier curves and multivariate logistic regression analysis were performed to identify the markers capable of influencing this progression.ResultsDuring the follow-up, the drop out was 4% in both groups. A total of 119 (56.1%) out of 212 LADA patients required insulin during the 7 years of follow-up. The Kaplan–Meier plots showed that 74/104 (71.1%) of high GADA titer required insulin compared with 45/108 (41.6%) of low GADA titer and with 86/412 (20.9%) of type 2 diabetes (P2and IA-2ICand zinc transporter 8 (ZnT8) positivity were also shown as the markers of faster progression (PPPConclusionsHigh GADA titer, BMI ≤ 25, ZnT8 and IA-2ICpositivity and sulfonylurea treatment, in the first year from diagnosis, significantly increase the progression toward insulin requirement in LADA patients.

From January 28th to February 10th, 2008 the Italian Society of Cardiac Rehabilitation and Prevention (GICR) conducted a national web-based survey aimed to provide specific and updated information on organization and core components of cardiac rehabilitation (CR) in Italy, and to describe, both in residential and out-patient settings, indications for CR, clinical characteristics of referred patients, risk profile, performed diagnostic procedures, exercise and educational programme, treatments and arrangements for the follow-up [1, 2]. The ISYDE-2008 is a multicenter, longitudinal, prospective observation study whose design was previously described [1, 2].