bluuebunny/crossref_metadata_2025 huggingface dataset:
A Parameter Adaptive MOMEDA Method Based on Grasshopper Optimization Algorithm to Extract Fault Features
Authors: Zhou ChengJiang , Ma Jun , Wu Jiande , Feng Zezhong
Published: March 2019

The nonstationary components and noises contained in the bearing vibration signal make it particularly difficult to extract fault features, and minimum entropy deconvolution (MED), maximum correlated kurtosis deconvolution (MCKD), and fast spectral kurtosis (FSK) cannot achieve satisfactory results. However, the filter size and period range of multipoint optimal minimum entropy deconvolution adjusted (MOMEDA) need to be set in advance, so it is difficult to achieve satisfactory filtering results. Aiming at these problems, a parameter adaptive MOMEDA feature extraction method based on grasshopper optimization algorithm (GOA) is proposed. Firstly, the multipoint kurtosis (MKurt) of MOMEDA filtered signal is used as the optimization objective, and the optimal filter size and periodic initial value which matched with the vibration signal can be determined adaptively through multiple iterations of GOA. Secondly, the periodic impact contained in the vibration signal is extracted by the optimized MOMEDA, and the fault features in the impact signal are extracted by Hilbert envelope demodulation. Finally, the simulation signal and bearing signal are processed by the proposed approach. The results show that the introduction of GOA not only solves the problem of parameter selection in MOMEDA, but also achieves better performance compared with other optimization methods. Meanwhile, the feasibility and superiority of the approach are fully proved by comparing it with the three methods MED, MCKD, and FSK after parameter optimization. Therefore, this approach provides a novel way and solution for fault diagnosis of the rolling bearing, gear, and shaft.
Does Pharmacological Treatment Reduce the Incidence of Lower Urinary Tract Symptoms (LUTS) after Transobturator Sling?
Authors: Rechberger Tomasz , Wrobel Andrzej , Zietek Alicja , Rechberger Ewa , Kulik-Rechberger Beata , Bogusiewicz Michal , Miotla Pawel
Published: March 2019

Aim. Lower urinary tract symptoms (LUTS) frequently affect patients immediately after midurethral sling (MUS) placement. The objective of the study was to assess if solifenacin or mirabegron decreases incidence of LUTS in women who underwent transobturator MUS. Methods. A prospective randomized trial was conducted on patients undergoing ambulatory transobturator midurethral sling due to stress urinary incontinence (SUI). All participants were questioned before and after surgery for occurrence of bothersome LUTS. A total of 328 patients who underwent transobturator MUS were randomly assigned to one of three groups: prophylaxis with 10 mg of solifenacin, prophylaxis with 50 mg of mirabegron, or without any additional treatment. LUTS evolution and efficacy of solifenacin and mirabegron were analyzed based on results of assessments made during follow-up visits at 1 and 6 weeks after surgery. Comparison of the prevalence of LUTS was done using chi2 test. Results. Prevalence of urgency and frequency episodes increased notably 1 week after sling placement and then came down to baseline levels. Solifenacin and mirabegron significantly reduced the incidence of urgency after 1 week, but after 6 weeks the beneficial effect was observed only in case of solifenacin. Treatment with mirabegron reduced the percentage of patients suffering from frequency after 6 weeks. Although prevalence of nocturia did not raise after sling placement, both treatments significantly reduced the incidence of this complaint after 6 weeks. Pharmacological treatment did not modulate the course of hesitancy and terminal dribbling. Conclusions. Treatment with solifenacin or mirabegron may significantly reduce the incidence of undesired LUTS after MUS.
Epicatechin Gallate Protects HBMVECs from Ischemia/Reperfusion Injury through Ameliorating Apoptosis and Autophagy and Promoting Neovascularization
Authors: Fu Bing , Zeng Qinghong , Zhang Zhaoting , Qian Mingyue , Chen Jiechun , Dong Wanli , Li Min
Published: March 2019

Green tea is one of the most beverages with antioxidants and nutrients. As one of the major components of green tea, (-)-epicatechin gallate (ECG) was evaluated for its antioxidative properties in the present study. Cell proliferation assay, tube formation, cell migration, apoptosis, and autophagy were performed in human brain microvascular endothelial cells (HBMVECs) after oxygen-glucose deprivation/reoxygenation (OGD/R) to investigate potential anti-ischemia/reperfusion injury properties of ECG in vitro. Markers of oxidative stress as ROS, LDH, MDA, and SOD were further assayed in our study. Data indicated that ECG could affect neovascularization and promote cell proliferation, tube formation, and cell migration while inhibiting apoptosis and autophagy through affecting VEGF, Bcl-2, BAX, LC3B, caspase 3, mTOR, and Beclin-1 expression. All the data suggested that ECG may be protective for the brain against ischemia/reperfusion injury by promoting neovascularization, alleviating apoptosis and autophagy, and promoting cell proliferation in HBMVECs of OGD/R.
Gene Expression Pattern and Regulatory Network of α-Toxin Treatment in Bombyx mori
Authors: Feng Tieshan , Lin Ping , Gong Jiao , Cheng Dong , Yang Xi , Zhang Quan , Cheng Tingcai
Published: March 2019

Bacillus bombyseptieus is a pathogen of Bombyx mori; it can cause bacterial septicemia in silkworm. One of the components of the parasporal crystal toxin of B. bombyseptieus, α-toxin, plays an important role in the process of infection in silkworm. In this study, we investigated the immune response of silkworm induced by α-toxin by using RNA-seq. We compared the changes in gene expression in the midgut, fatbody, and hemocytes of silkworm and in the B. mori embryonic cell line (BmE) after treatment with α-toxin and identified 952 differentially expressed genes and 353 differentially expressed long noncoding RNAs (lncRNAs). These regulated genes in different tissues were found to be enriched in different pathways. The upregulated genes in the midgut were mainly involved in peptidoglycan catabolic process and tyrosine kinase signaling pathway, whereas the downregulated genes were mainly involved in chitin metabolic pathways. The upregulated genes in fatbody were also involved in peptidoglycan catabolic process, but they were for a different peptidoglycan subtype. Further, genes encoding cecropins were enriched in the fatbody. The downregulated genes were mainly involved in the metabolic pathways of fundamental substances such as cellular protein metabolic process and nucleobase-containing compound metabolic process. These results suggest that α-toxin can induce various immune responses in silkworm, and further studies are warranted to understand the mechanism of α-toxin action in silkworm. Further, lncRNAs and differentially expressed genes were correlated using coexpression network analysis. Our findings revealed potential candidate genes and lncRNAs that might play important physiological functions in the immune response to α-toxins in silkworm.
Perturbed Biochemical Pathways and Associated Oxidative Stress Lead to Vascular Dysfunctions in Diabetic Retinopathy
Authors: Mahajan Nidhi , Arora Palkin , Sandhir Rajat
Published: March 2019

Diabetic retinopathy (DR) is a vascular insult that accompanies the hyperglycemic state. Retinal vasculature holds a pivotal role in maintaining the integrity of the retina, and any alteration to retinal vasculature affects retinal functions. The blood retinal barrier, a prerequisite to vision acuity, is most susceptible to damage during the progression of DR. This is a consequence of impaired biochemical pathways such as the polyol, advanced end glycation products (AGE), hexosamine, protein kinase C (PKC), and tissue renin-angiotensin system (RAS) pathways. Moreover, the role of histone modification and altered miRNA expression is also emerging as a major contributor. Epigenetic changes create a link between altered protein function and redox status of retinal cells, creating a state of metabolic memory. Although various biochemical pathways underlie the etiology of DR, the major insult to the retina is due to oxidative stress, a unifying factor of altered biochemical pathways. This review primarily focuses on the critical biochemical pathways altered in DR leading to vascular dysfunctions and discusses antioxidants as plausible treatment strategies.
Acceptance and Use of Innovative Assistive Technologies among People with Cognitive Impairment and Their Caregivers: A Systematic Review
Authors: Thordardottir Björg , Malmgren Fänge Agneta , Lethin Connie , Rodriguez Gatta Danae , Chiatti Carlos
Published: March 2019

Cognitive impairments (CI), associated with the consequences of Alzheimer’s disease and other dementias, are increasingly prevalent among older adults, leading to deterioration in self-care, mobility, and interpersonal relationships among them. Innovative Assistive Technologies (IAT) such as electronic reminders and surveillance systems are considered as increasingly important tools to facilitate independence among this population and their caregivers. The aim of this study is to synthesise knowledge on facilitators and barriers related to acceptance of and use of IAT among people with CI and their caregivers. This systematic review includes original papers with quantitative, qualitative, or mixed methods design. Relevant peer-reviewed articles published in English between 2007 and 2017 were retrieved in the following databases: CINAHL; PubMed; Inspec; and PsycINFO. The Mixed Method Appraisal Tool (MMAT) was used for quality assessment. We retrieved thirty studies, including in total 1655 participants from Europe, USA/Canada, Australia, and Asia, enrolled in their homes, care-residences, day-care centres, or Living Labs. Two-thirds of the studies tested technologies integrating home sensors and wearable devices for care and monitoring CI symptoms. Main facilitators for acceptance and adherence to IAT were familiarity with and motivation to use technologies, immediate perception of effectiveness (e.g., increase in safety perceptions), and low technical demands. Barriers identified included older age, low maturity of the IAT, little experience with technologies in general, lack of personalization, and support. More than 2/3 of the studies met 80% of the quality criteria of the MMAT. Low acceptance and use of IAT both independently and with caregivers remains a significant concern. More knowledge on facilitators and barriers to use of IAT among clients of health care and social services is crucial for the successful implementation of innovative programmes aiming to leverage innovative technologies for the independence of older people with CI.
Global Synchronization of Delayed Complex Networks with Hybrid Coupling, Control Design of Actuator Saturation, and Stochastic Disturbances with Randomly Occurring Nonlinearities
Authors: Ali M. Syed , Usha M. , Saravanan S. , Zhu Quanxin
Published: March 2019

In this paper, we propose and study a global synchronization of delayed complex networks with hybrid coupling, which is composed of constant coupling, discrete‐delay coupling, and unbounded distributed‐delay coupling, and its actuator saturation control design is then further investigated. Several effective sufficient conditions of global synchronization are attained based on the Lyapunov function and a linear matrix inequality (LMI), which can be easily computed by the interior‐point method. In addition, we established the control design of actuator saturation of the addressed stochastic delayed complex networks. More relaxed conditions by employing the new type of augmented matrices by using multitude Kronecker product terms can be handled, which can be introduced. Finally, a numerical example is provided to demonstrate the effectiveness of the proposed synchronization scheme.
Systemic Treatment for Advanced Hepatocellular Carcinoma
Authors: Bouattour Mohamed , Mehta Neil , He Aiwu R. , Cohen Emil I. , Nault Jean-Charles
Published: March 2019

Background: Patients with advanced hepatocellular carcinoma (HCC) have a poor prognosis. First-line sorafenib has been the standard of care for a decade, but the treatment landscape is expanding. This review provides a practical overview of current and future systemic treatment options for advanced HCC and their place in clinical practice. Summary: First-line sorafenib and lenvatinib have shown to improve the survival of patients with advanced HCC. In the second line, regorafenib provides benefit for patients who previously tolerated sorafenib. Anti-PD1 antibodies, nivolumab and pembrolizumab, recently became available for second-line use in the US. Ramucirumab (for patients with α-fetoprotein [AFP] levels ≥400) and cabozantinib present potential future second-line treatment options. Combinations of systemic and locoregional treatment, such as radiofrequency ablation or selective internal radiotherapy, require further research. Precision medicine has not yet been translated into clinical practice, as the most common driver mutations (TERT promoter, CTNNB1, TP53, and ARID1A mutations) have not yet been shown to be suitable therapeutic targets. However, our growing understanding of signaling pathways and efforts in drug development are expected to pave the way for precision medicine in HCC in the future. Evaluating the place for the current and novel systemic treatment options in clinical practice can be challenging due to the diverse toxicity profiles of the treatment options and characteristics of the patient population. Sorafenib data elucidate the effect patient characteristics (such as the performance score, Child-Pugh class, AFP, etiology of the underlying disease, and level of macrovascular invasion and extrahepatic spread) may have on outcomes in advanced stages. Key Messages: Lenvatinib is expected to join sorafenib as a preferred first-line treatment in advanced HCC. In the second line, the treatment of choice, regorafenib, is soon expected to be accompanied by cabozantinib and ramucirumab in patients with AFP ≥400 ng/mL, whereas nivolumab and pembrolizumab present second-line alternatives in the US.
Cup-Shaped Tooth Wear Defects: More than Erosive Challenges?
Authors: Ruben Jan L. , Roeters F. Joost M. , Truin Gert-Jan , Loomans Bas A.C. , Huysmans Marie-Charlotte D.N.J.M.
Published: March 2019

Background/Aim: The underlying mechanism of the development of cups and grooves on occlusal tooth surfaces is still unclear. The aim of this study was to evaluate factors contributing to in vitro cup formation, in order to elucidate the clinical process. Methods: A total of 48 extracted human molar teeth were exposed to acidic aqueous solutions at pH of 4.8 and 5.5 in constant motion, in combination with different loading conditions: no load (0N group, control), 30 N (30N group) or 50 N (50N group) (n = 8 per group). Before and after 3 months of exposure (1,422,000 loading cycles), the samples were scanned using a non-contact profilometer. Pre- and post-exposure scans were subtracted and height loss and volume tissue loss were calculated. Representative samples with wear and cupping lesions were imaged using scanning electron microscopy, light microscopy and micro-computed tomography. Results: Average height and volume tissue loss at pH 5.5 was 54 µm and 3.4 mm3 (0N), 52 µm and 3.4 mm3 (30N) and 58 µm and 3.7 mm3 (50N), respectively, with no statistically significant differences. Average height and volume loss at pH 4.8 were 135 µm and 8.7 mm3 (0N), 172 µm and 12.6 mm3 (30N) and 266 µm and 17.8 mm3 (50N), respectively, with a statistically significant difference between 0N and 50N (p < 0.002). Cup-shaped lesions had formed only at pH of 4.8, in the 30N and 50N groups. Conclusion: The study showed that a cup can arise fully in enamel and that mechanical loading in addition to erosive challenges are required.
A Study on the Status of Proton Pump Inhibitor Prescriptions Using Diagnosis Procedure Combination Data in Japan
Authors: Sakata Yasuhisa , Tsuruoka Nanae , Takedomi Hironobu , Akutagawa Takashi , Shimoda Ryo , Esaki Motohiro , Fujimoto Kazuma
Published: March 2019

Background/Aims: Proton pump inhibitors (PPIs) are widely used for the management of acid-related diseases. This study aimed to clarify the status of PPI use in hospitalized patients. Method: A retrospective observational study was performed. We analyzed PPI prescription data for the past 8 years (2009–2016) using Diagnosis Procedure Combination survey data from approximately 10,000 patients per year at Saga University Hospital. We investigated the trend in the number of hospitalized patients who were prescribed PPI for the past 8 years and the changes in patient characteristics. Results: We identified 11,009 patients using PPIs throughout the study period. PPI prescription proportions significantly increased over the study period. The use of PPIs increased steadily with increasing age. The proportion of PPIs prescribed was 1.3-times higher among men than compared with women. In most clinical departments, the number of patients prescribed PPIs was up to 3 times higher in the second half of the period (2013–2016) compared with the first half of the period (2009–2012). The number of patients taking concomitant PPIs and anticoagulants or dual antithrombotic combination therapy increased. Conclusion: PPI use has increased substantially in hospitalized patients. The prevalence of PPI prescription by doctors other than gastroenterologists also increased.
BULLOUS PEMPHIGOID A RARE AUTOIMMUNE DISEASE: A CASE REPORT
Authors: Biradar S. M. , Dhanavidya S. , Kavya P. , Keerthi T. , Sunanda N. , Marapur S. C. , Warad Vijaykumar , Kalyane N. V.
Published: March 2019

Background. Bullous pemphigoid (BP) is a rare autoimmune blistering skin disease in the elderly and it is manifested by cutaneous blisters on the skin lesions.

The objective was to emphasize the rare case of BP.

Methods. A case report of BP in a 58-year-old male patient admitted to a dermatology ward is presented.

Results. A 58-year-old male patient with complaints of fluid-filled skin lesions, was examined initially over the trunk, gradually progressed involving B/L upper and lower extremities. Even though the patient was treated with the recommended therapy of corticosteroid (Dexamethasone) along with adjuvant drugs, new skin lesions continued to develop, and the patient’s condition worsened. The Prednisolone was started in place of Dexamethasone on the fifth day of treatment at its higher dose (50mg/day), the Prednisolone proved its efficacy to combat the extensive condition of BP.

Conclusions. Bullous pemphigoid is a distressing blistering skin disease. Untreated disease is often fatal because of the susceptibility to infection and fluid-electrolyte disturbances. The mortality of patients with bullous pemphigoid has been significantly reduced with the advent of new therapies and treatment modalities. The treatment with systemic and topical corticosteroids forms the mainstay of treatment along with other adjuvant drugs. In the present case study, the use of Prednisolone has proven its efficacy in the extensive disease state of BP and improved the patient’s quality of life.
MICROBIOTA OF VAGINA AND MAMMARY GLANDS SKIN IN THE PREGNANT WOMEN WITH PREECLAMPSIA
Authors: Ivankiv V. Ya. , Malanchyn I. M. , Tkachuk N. I.
Published: March 2019

Background. Timely prediction, diagnosis and prevention of complications during the gestational period leading to perinatal loss and maternal mortality are the main tasks of contemporary obstetrics. About 50,000 women die from preeclampsia and eclampsia every year and perinatal mortality ranges from 15 to 25%.
Objective. The aim of the research was to study and analyze the microecology of vagina and mammary glands skin in the pregnant women with underlying preeclampsia.
Methods. The pregnancy examination was conducted at the Ternopil Regional Clinical Perinatal Center “Mother and Child”. The research involved 25 pregnant women with preeclampsia (the main group) and 15 healthy women with a physiological course of pregnancy (the control group). Material from the pregnant women was taken out of the skin of mammary glands and mucous membrane of vagina, then it was plated out in the nutrient medium for the cultivation and the microorganisms were defined.
Results. The quantitative composition of a normal microflora of vagina and mammary glands skin in the control group was within the normal range. The quantitative composition of a normal microflora of vagina and mammary glands skin in the pregnant women of the main group decreased, the representatives of opportunistic and pathogenic flora were found.
Conclusions. In the pregnant women with preeclampsia, abnormal microbiocenosis of vagina and breast skin was revealed, the degree of abnormality correlated with the severity of the disease. Our results may provide useful clinical knowledge to a broader understanding of microbiota role in pregnancy complications.
PREVALENCE AND RISK FACTORS FOR VITAMIN D DEFICIENCY IN OVERWEIGHT AND OBESE ADOLESCENTS IN UKRAINE
Authors: Shulhai A-M. A. , Pavlyshyn H. A.
Published: March 2019

Background. Vitamin D affects the function of many organs and systems. Lipid metabolism disorder is established to be one of the risk factors for vitamin D deficiency, and the amount of adipose tissue is crucial.

Objective. The aim of the study was to determine the prevalence and risk factors for vitamin D deficiency in overweight and obese adolescents.

Methods. 146 children with excessive weight and obesity as well as 63 healthy children with normal body weight were examined. In the study groups, there were no children taking vitamin D. Vitamin D status was evaluated by the level of 25(OH)D in blood serum. Vitamin D deficiency was diagnosed at the level of 25(OH)D between 20 and 29 ng/ml, and significant deficiency – below 20 ng/ml, normal calcidiol content was 30-100 ng/ml.

Results. The average level of 25(OH)D in the adolescents with normal body weight was 19.76±4.28 ng/ml, in the adolescents with excessive body weight – 15.24±3.47 ng/ml, and in the obese children – 13.87±2.71 ng/ml. The prevalence of vitamin D deficiency in the overweight adolescents was 70.62%, and in the adolescents with obesity – 77.19%.

Conclusions. Vitamin D deficiency is prevalent in the adolescents with overweight and obesity. To prevent the development of hypovitaminosis and vitamin D deficiency, it is necessary to carry out educational activities with adolescents for promotion of healthy lifestyle and healthy food, as well as to develop an optimal program for improving vitamin D status in the obese children.
MORPHOLOGICAL RESPONSE TO IMPLANTATION OF A POLYPROPYLENE MESH WITH A PRF MEMBRANE IN PATIENTS WITH POSTOPERATIVE VENTRAL HERNIA AND UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA
Authors: Piatnochka V. I. , Prodan A. M.
Published: March 2019

Background. Current herniology promotes the widespread usage of mesh implants in the primary treatment and, especially, in the for postoperative ventral hernias.

Objective. The aim of the research was to study the morphological response of the tissues of muscular aponeurotic layer to implantation of a polypropylene mesh with using PRF membrane-enriched platelets in the patients with postoperative ventral hernia and concomitant undifferentiated dysplasia of connective tissues.

Methods. The research involved 98 patients with postoperative ventral hernia, who underwent retro-muscular alogernioplasty by the Sublay technique of implantation of ‘light’ meshes, and a ‘light’ polypropylene mesh (PPM) in combination with a platelet-rich fibrin (PRF) membrane. The patients were divided into experimental groups according to the presence of undifferentiated connective tissue dysplasia syndrome.

Results. Microscopic studies carried out after the implantation of a polypropylene mesh with a PRF membrane has proved that structural changes in connective tissues are like those of a polypropylene mesh, but they are less significant. There was a leukocyte infiltration near the mesh material, but its area was small. The enlargement and blood filling of the vessels of microcirculatory channel was a manifestation of the increased vascularization of this area.

Conclusions. The usage of a polypropylene mesh in combination with a PRF membrane in the surgical treatment of postoperative ventral hernias reduces inflammatory changes in the tissues significantly and increases the activation of fibroblasts and signs of collagen fibers around the mesh material that is relevant especially for the patients with connective tissue pathology.
Regime diferenciado de contratações públicas e contratação por resultados no Brasil
Authors: Sales Pedro Carneiro
Published: March 2019

Este trabalho objetiva, em síntese, o estudo da contratação por resultados como instrumento de ampliação da eficiência da Administração Pública. Para isto, a pesquisa é iniciada com a análise do cenário internacional e as principais espécies de contratos por resultado: Payment by Results (PbR) e Social Impact Bonds (SIBs), que têm como traço comum a transferência para o particular dos riscos financeiro e operacional na prestação de serviços de interesse público e a remuneração proporcional aos resultados. Estudar-se-á, ainda, o Regime Diferenciado de Contratações Públicas, inaugurado no Brasil para atender aos grandes eventos esportivos e posteriormente perenizado. Será demonstrado que o RDC inovou a contratação pública no Brasil com algumas características, como possibilidade de contratação integrada, sigilo do orçamento estimado, inversão de fases da licitação e previsão de um recurso único, tudo para garantir mais celeridade (na licitação e na execução do contrato) e evitar o conluio e outros ataques à concorrência pública. Por fim, serão estudados os contratos por resultados previstos no RDC – contrato de remuneração variável e contrato de eficiência – para fazer uma análise comparatista com o PbR e as SIBs e avaliar a implementação destas no Brasil sob o marco daquele regime diferenciado.
O poder normativo das agências reguladoras e a constitucionalidade dos princípios inteligíveis
Authors: Arigony Alexandre Foch
Published: March 2019

As agências reguladoras exercem poder normativo com base em leis que, de forma ampla e abstrata, preveem o que a doutrina convencionou chamar de princípios inteligíveis. Os princípios inteligíveis somente estabelecem parâmetros e objetivos a serem alcançados pela agência reguladora. O legislador apenas fixa balizas à agência reguladora, ainda que largas, pautadas por standards. Há uma certa tensão dos princípios inteligíveis com a acepção clássica do princípio da legalidade. Assim, alguns autores administrativistas sustentam a inconstitucionalidade desta técnica legislativa e defendem uma visão maximalista da lei: as entidades administrativas devem apenas executar a lei. O trabalho demonstra que a utilização dos princípios inteligíveis é constitucional e consentânea com a realidade atual, havendo outros mecanismos de controle da Administração Pública. Analisa, ainda, o atual entendimento acerca do princípio da legalidade. Em seguida, examina a constitucionalidade do desenho institucional brasileiro de criação de agências reguladoras com amplos poderes normativos para editar atos infralegais a partir de princípios inteligíveis constantes da lei de sua criação. Por fim, aborda um caso concreto julgado pelo STF envolvendo os limites de competência de agência reguladora.
As agências reguladoras brasileiras e seus problemas jurídicos
Authors: Gracindo Gabriel Rosa
Published: March 2019

A compreensão do desenho institucional que envolve as Agências Reguladoras Independentes no cenário regulatório americano e brasileiro é de extrema relevância para que possam ser feitas as comparações entre os modelos de ambos os países e sejam traçados paralelos que auxiliem na solução dos problemas de natureza jurídica enfrentados no cotidiano da regulação no Brasil desde a implementação das entidades. No estudo comparado das Agências Reguladoras e dos respectivos transplantes institucionais realizados, a identificação das peculiaridades políticas e jurídicas locais em confronto com o modelo importado pode auxiliar na mudança incremental do desenho normativo da regulação no Brasil, fortalecendo as instituições e promovendo, por consequência, o desenvolvimento econômico, político e social do país ao garantir um ambiente regulatório estável e dotado de segurança jurídica.
Novo regime jurídico dos contratos das empresas estatais
Authors: França Vladimir Da Rocha , França Catarina Cardoso Sousa
Published: March 2019

O objetivo do presente ensaio é descrever e analisar as normas jurídicas veiculadas pela Lei Federal nº 13.303/2016, pertinentes aos contratos celebrados por empresas estatais (empresas públicas, sociedades de economia mista e suas subsidiárias), com o emprego da metodologia preconizada pela dogmática jurídica (ou Ciência do Direito em sentido estrito). Pode-se identificar as seguintes derrogações de Direito Público no regime jurídico dos contratos disciplinados pela Lei Federal nº 13.303/2016: (i) a exigência de prévio processo administrativo para a celebração do negócio jurídico; (ii) o direito da empresa estatal de exigir garantias do contratado e (iii) a competência da empresa estatal para aplicar sanções administrativas ao contratado. No mais, esses contratos das empresas estatais estão sujeitos ao regime jurídico de Direito Privado. Portanto, o contratante tem os mesmos direitos do particular, ressalvadas aquelas prerrogativas especiais que a lei ainda lhe reconhece – direitos estes que não perdem o seu caráter instrumental em face do interesse público, até mesmo por injunção do princípio da função social do contrato.
Abstract 017: Impact of Gentrification on Cardiovascular Disease Surveillance Using Data from the Electronic Health Record
Authors: Bhavsar Nrupen A , Shepherd-Banigan Megan , Phelan Matthew , Goldstein Benjamin A , Lunyera Joseph , Diamantidis Clarissa J , Maciejewski Matthew L , Boulware Ebony
Published: March 2019

Introduction:
Current static approaches of CVD surveillance may not capture the true health of neighborhoods as the influx of younger, healthier, and wealthier individuals (i.e., gentrification) can impact long term residents (LTR) who can be older and of lower socioeconomic status (SES), potentially biasing prevalence estimates.

Hypothesis:
LTR in gentrifying vs. LTR in non-gentrifying neighborhoods will have a lower prevalence of CVD related conditions.

Methods:
We quantified the census tract prevalence of diabetes (DM), hypertension (HTN), obesity, and CVD (myocardial infarction or stroke hospitalization) using electronic health record (EHR) data from the Duke Health System and Lincoln Community Health Center from 2008-2010 and 2014-2016. The EHR population was 116,760 patients living in Durham County in 2008 followed until 12/31/16. LTR were patients with the same 2010 and 2015 address; patients moving in/out (i.e., movers) did not have a recorded address in 2010 or 2015. A census tract was defined as gentrifying if 3 of 4 SES indicators (positive z-score for median household income, median rental price, % with bachelor’s degree, or a negative z-score for % living below the poverty line) improved. In difference-in-difference (DiD) analysis, we compared changes in prevalence of CVD health indicators between LTR in gentrifying and non-gentrifying neighborhoods.

Results:
At baseline, patients had a median age of 43 years, 42% were black and 61% were female. The overall prevalence of DM, HTN, obesity, and CVD was 12%, 32%, 19%, and 5% in 2010 & 14%, 31%, 32%, and 7% in 2016. The prevalence increased in gentrifying and non-gentrifying neighborhoods over time and was higher in LTR than comparable movers. Estimates from DiD models were not statistically significant (Figure 1).

Conclusions:
LTR vs. movers and not gentrification impacted the surveillance of CVD health indicators. Novel public health informatics methods are needed to address dynamic changes in neighborhoods that may bias the enumeration of CVD health indicators.
Abstract 018: New York City Youth Cardiovascular Fitness and Subsequent School Absenteeism Have an Inverse, Dose-Response Relationship, Regardless of How Poverty is Measured
Authors: D’Agostino Emily M , Day Sophia E , Konty Kevin J , Wyka Katarzyna
Published: March 2019

Introduction:
Recent research demonstrates that cardiovascular fitness improvements are associated with lower absenteeism, particularly for girls attending schools located in high poverty neighborhoods. Poverty at the student, school, and neighborhood levels may each have unique effects on both cardiovascular fitness and school absenteeism. There is a need to simultaneously explore the effects of poverty measures collected at different levels of observation on the longitudinal fitness-absenteeism relationship and across gender in order to inform policy targeting reduced school absenteeism.

Hypothesis:
It was hypothesized that poverty measured at the neighborhood level would have the strongest magnitude of effects on the cardiovascular fitness-absenteeism relationship compared with poverty measured at the school and student levels.

Methods:
Data for this study were drawn from the New York City Fitnessgram dataset. Inclusion criteria were enrollment in a New York City public school for at least 2 consecutive years in grades 6-8 (2006-2013) while attending a school that collected Fitnessgram measurements. Negative binomial longitudinal mixed models with random-intercepts were run to test the association between the exposure, child-specific change in cardiovascular fitness from the year prior, and the outcome, days absent the subsequent year. Separate crude and adjusted models were run stratified by student (individual household), school (percent of students living in poverty or qualifying for free/reduced price school meals) and neighborhood (home- and school-area) poverty measures, and also by gender. Models were adjusted for individual- and group-level confounders (time, grade, race/ethnicity, place of birth, change in obesity status, and school size), and clustering by individual student and school.

Results:
The sample included 360,743 students (67% black or Hispanic, 51% male, 69% qualifying for free/reduced price school meals). Adjusted estimates showed an inverse-dose response fitness-absenteeism relationship across all poverty measures, with the highest magnitude of effects for youth attending schools in high poverty neighborhoods (IRR= -0.12, 95%CI: -0.20, -0.04 in girls; IRR= -.13, 95%CI: -.29, .03 in boys), and in girls attending schools with a high proportion of students qualifying for free/reduced school meals (IRR= -.11, 95%CI: -.23, -.01).

Conclusions:
In conclusion, there is an inverse, dose-response trend between cardiovascular fitness and subsequent absenteeism in high poverty youth, regardless of how poverty is measured, and particularly among girls. Future research should examine the potential for distinct youth physical activity interventions tailored to the individual, school and neighborhood levels to reduce school absenteeism associated with poverty.
Abstract 020: Age-Associated Rise in Arterial Stiffness Among Hunter-Gatherers
Authors: Zhang Mingyu , Noya-Alarcon Oscar , Contreras Monica , Tanaka Hirofumi , Matsushita Kunihiro , Appel Lawrence J , Dominguez-Bello Maria G , Mueller Noel T
Published: March 2019

Introduction:
Elevated blood pressure (BP) and arterial stiffness increase cardiovascular disease risk. While BP and arterial stiffness both increase with age in most westernized populations, BP does not rise with age in isolated hunter-gatherers, including Yanomami, where vascular disease is uncommon. No studies have examined if arterial stiffness rises with age among Yanomami or the geographically collocated Yekwana.

Methods:
In a pilot study conducted in February 2016, we sampled participants from 5 isolated Yanomami-Sanema villages and 3 Yekwana villages in the Upper Caura River Basin, a remote area of the Venezuelan Amazon. Trained staff measured cardio-ankle vascular index (CAVI) per standard protocols, and height and weight to determine body mass index (BMI). We used ANCOVA to compare the age-CAVI association between Yanomami and Yekwana, and further compared associations with data from US whites and Japanese female volunteers for physiological studies with CAVI measurement.

Results:
80 participants (63 Yekwana; 17 Yanomami) age 11-72 years had data on CAVI. A 5-year increment in age was associated with a 0.24 unit (95% CI: 0.17, 0.31) and a 0.25 unit (95% CI: 0.14, 0.35) increase in CAVI in Yekwana and Yanomami, respectively (Figure). The age-CAVI slope did not differ in these two populations (p=0.95). Compared to Yanomami and Yekwana individuals, a 5-year increment in age was associated with a significantly greater increase in CAVI in US whites (0.12, 95% CI: 0.04, 0.20) and a non-significantly greater increase in Japanese females (0.08, 95% CI: -0.02, 0.18). Estimates did not markedly change after adjusting for BMI.

Conclusion:
In Yekwana and Yanomami individuals with hunter-gatherer lifestyles, arterial stiffness increased with age, in a manner similar to Japanese females but less steep than US whites. Taken together with our previous finding that BP does not rise with age in Yanomami and minimally in Yekwana, our preliminary findings suggest that rise in arterial stiffness with age might be independent of BP.
Abstract 022: Exploring the 24 Hour Day: using Isotemporal Substitution to Model the Cardiometabolic Benefits of Sleep Duration in Older Women
Authors: Full Kelsie M , Kerr Jacqueline , Malhotra Atul , Gallo Linda , Bellettiere John , Arredondo Elva , Stone Katie L , Zaslavsky Oleg , Lewis Cora E , Lin Xiaochen , LaCroix Andrea Z
Published: March 2019

Background:
Sleep, sedentary behavior (SB), and physical activity (PA) are independently associated with cardiometabolic health, but few studies have examined the interrelationships between 24 hour activity and cardiometabolic risk factors. Extending sleep may be a feasible cardiometabolic risk reduction strategy; however, research is needed to understand how replacing time in SB and/or PA with sleep impacts cardiometabolic risk.

Methods:
Women’s Health Initiative participants in the OPACH Study (N=3329; mean age=78.5±6) wore ActiGraph GT3X+ accelerometers 24 hours/day for up to 7 days. Sleep duration was derived using a validated protocol. Adjusted regression models estimated the relationship between sleep duration and cardiometabolic markers. Separately for shorter (<8 hours) and longer (≥8 hours) sleepers, isotemporal substitution models estimated the change in cardiometabolic risk markers associated with reallocating time in daytime activity (SB, light PA (LIPA), moderate to vigorous (MVPA)) to or from sleep.

Results:
Longer sleep duration was significantly associated with higher insulin, HOMA-IR, total cholesterol, triglycerides, and Reynolds Risk Score (RRS) (all p < 0.05). For shorter sleepers, reallocating 33 minutes of MVPA to sleep was associated with significantly
higher
values of insulin, HOMA-IR, triglycerides, waist circumference, and RRS (0.9%-11.4%) (Figure 1). Replacing 91 minutes of SB time with sleep was associated with significantly
lower
waist circumference (-1%). In longer sleepers, reallocating 74 minutes from sleep to LIPA was associated with significantly
lower
values of insulin, HOMA-IR, trigylcerides, and waist circumference (-1.4% - -12.3%).

Conclusions:
This is one of the first isotemporal analysis to include objectively measured sleep duration. Results illuminate possible cardiometabolic risks and benefits of reallocating time to or from sleep duration.
Abstract 028: Increase in Abdominal Visceral Adipose Tissue Accelerates Two Years Prior to Menopause: The Study of Women’s Health Across the Nation (SWAN) Heart
Authors: Samargandy Saad , Matthews Karen A , Brooks Maria M , Barinas-Mitchell Emma , Magnani Jared W , Janssen Imke , Kazlauskaite Rasa , El Khoudary Samar R
Published: March 2019

Introduction:
Abdominal visceral adipose tissue (VAT) contributes to pathogenesis of cardiometabolic disease through endocrine and paracrine secretion of adipocytokines. Midlife women experience adipose tissue redistribution towards increasing central adiposity. A few studies suggested a contribution of the menopausal transition, but evidence is lacking to characterize the change in VAT relative to time of the final menstrual period (FMP). We hypothesized that VAT would change non-linearly relative to FMP with a significant rise close to FMP.

Methods:
We evaluated participants with no self-reported CVD from the SWAN Heart Ancillary study. Women had up to two computed tomographic planimetric measurements of VAT over a median of 2.2 years of follow-up and known dates of FMP. LOESS splines were used to determine potential inflection points of VAT change relative to FMP. Piecewise linear mixed-effects models were used to estimate and compare yearly % changes in VAT at LOESS spline-identified time segments.

Results:
The study included 321 women (at baseline: mean age (SD) of 51.0 (2.8) years; 60% White, 40% Black; 9% premenopausal, 51% early/ 13% late perimenopausal, and 27% postmenopausal). LOESS splines suggested a non-linear association between VAT change and time of FMP with two inflection points demarcating 3 segments: segment 1: > 2 years before FMP, segment 2: 2 years before FMP to the FMP, and segment 3: after FMP
(Figure)
. Adjusting for covariates listed under the
Figure
, VAT increased significantly by 10.5% (95% CI: 5.9, 15.3) per year in segment 2, and this increase was greater than changes in segments 1 [1.3% (-2.0, 4.7)] and 3 [3.1% (0.8, 5.4)], both P=0.01. Additional adjustment for concurrent body mass index attenuated difference only between segments 2 and 3 (P=0.07).

Conclusions:
Women show significantly faster increase in VAT two years prior to menopause, which may place them at greater risk of cardiometabolic outcomes later in life. These results encourage lifestyle modifications early in menopausal transition.
Abstract 029: Cardiovascular Health and Cognitive Decline in Older Adults: The Cardiovascular Health Study
Authors: MaWhinney Kristine , Tounkara Mamadou D , Evans Kirsten , Startup Emily , Ehlert Alexa , Covey Emarie , Westra Jordan , Blades Natalie J , Dhamoon Mandip S , Gonzalez Hector M , Imamura Fumiaki , Kuzma Elzbieta , Llewellyn David J , Novilla M Lelinneth B , Scrobotovici Monica , Longstreth W T , Thacker Evan L
Published: March 2019

Objective:
The AHA Life’s Simple 7 (LS7) defines cardiovascular health with smoking, physical activity, diet quality, body mass index (BMI), blood pressure, total cholesterol, and blood glucose. We examined associations of LS7 score and its components with cognitive decline in older adults.

Methods:
The Cardiovascular Heart Study is a longitudinal cohort of 5,888 adults aged 65 and above. We analyzed 4,165 who had LS7 score measured at baseline (1989), complete covariate data, and at least one Modified Mini-Mental State Examination (3MS) score during follow-up (through 1998). We scored each LS7 component as ideal (2), intermediate (1), or poor (0), summed all components to a total LS7 score ranging from 0 (worst) to 14 (best), and categorized total LS7 score as ideal (10-14), intermediate (5-9), or poor (0-4). 3MS is a measure of global cognition ranging from 0 (worst) to 100 (best) and was obtained annually during a mean follow-up of 6.8 years. Using linear mixed models, we estimated associations of LS7 score and its components with annual rate of cognitive decline, adjusted for demographic, behavioral, and clinical factors.

Results:
In adjusted models, mean annual decline in 3MS score was 0.83 points (95% CI: 0.61, 1.04) for those with poor LS7 scores at baseline, 0.63 points (95% CI: 0.59, 0.67) with intermediate scores, and 0.42 points (95% CI: 0.37, 0.47) with ideal scores (p < 0.0001 for difference in mean annual decline across LS7 categories). Better physical activity, diet quality, blood pressure control, and blood glucose control were all associated with slower cognitive decline (Table). BMI, however, was opposite, with obesity (poor) associated with slower decline, and normal weight (ideal) associated with faster decline (p <0.0001).

Conclusions:
Better cardiovascular health measured by LS7 in old age is associated with slower average cognitive decline. The role of BMI as a component of LS7 in older adults may warrant reconsideration, as lower BMI in late-life may represent frailty and increased risk for cognitive decline.
Abstract 036: Contemporary Estimates of Obesity Incidence of Among Children in the United States
Authors: Hardy Shakia T , Ng Carmen , Cunningham Solveig , Kramer Michael
Published: March 2019

Introduction:
Childhood obesity is a growing epidemic in the United States with approximately 1 in 5 children being obese. Although prevalence estimates for childhood obesity are regularly updated, little is known about the current incidence of childhood obesity among a nationally representative population, since initial estimates were provided by the Early Childhood Longitudinal Study Kindergarten (ECLS-K) Class of 1998.

Methods:
We estimated the annual incidence of obesity and the cumulative incidence of obesity over 5 years using the contemporary ECLS-K Class of 2011 (analytic sample = 7019). Height and weight were measured at eight time points between kindergarten (2010) and fourth grade (2015). We defined normal weight (<85
th
percentile), overweight (85
th
-95
th
percentile), and obesity (>95
th
percentile) using Centers for Disease Control and Prevention sex-and age-specific growth curves.

Results:
At kindergarten entry (mean age 5.6 years), 15.5% of children were overweight and 14.7% of children were obese; in fourth grade (mean age 10.1 years) overweight prevalence had increased to 17.3% and obesity prevalence had increased to 20.1%. Kindergarteners who were overweight were 6 times as likely as normal-weight kindergarteners to become obese by fourth grade (5-year cumulative incidence, 30.5% vs. 5.2%). In early elementary school, annualized obesity incidence proportions were higher over summer breaks (5.6% and 5.4% during summer breaks from Kindergarten to first grade and first grade to second grade, respectively) than during the school year (3.8% and 3.8% during Kindergarten and first grade school years, respectively). Incident obesity was higher among boys compared girls, non-Hispanic black and Hispanic children compared to non-Hispanic white children, and among those from the poorest socioeconomic quintiles compared to the highest socioeconomic quintile.

Conclusions:
Incident obesity between the ages of 5 and 10 years was more likely to have occurred during summer breaks and primarily among children who had entered kindergarten overweight. Childhood obesity prevention efforts should focus on the prevention of overweight prior to kindergarten and investigate causes of summer weight gain during elementary school.