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Blood pressure measurement is a marker of antenatal care quality. In well resourced settings, lower blood pressure cutoffs for hypertension are associated with adverse pregnancy outcomes. We aimed to study the associations between blood pressure thresholds and adverse outcomes and the diagnostic test properties of these blood pressure cutoffs in low-resource settings.We did a secondary analysis of data from 22 intervention clusters in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials (NCT01911494) in India (n=6), Mozambique (n=6), and Pakistan (n=10). We included pregnant women aged 15-49 years (12-49 years in Mozambique), identified in their community by trained community health workers, who had data on blood pressure measurements and outcomes. The trial was unmasked. Maximum blood pressure was categorised as: normal blood pressure (systolic blood pressure [sBP]120 mm Hg and diastolic blood pressure [dBP]80 mm Hg), elevated blood pressure (sBP 120-129 mm Hg and dBP80 mm Hg), stage 1 hypertension (sBP 130-139 mm Hg or dBP 80-89 mm Hg, or both), non-severe stage 2 hypertension (sBP 140-159 mm Hg or dBP 90-109 mm Hg, or both), or severe stage 2 hypertension (sBP ≥160 mm Hg or dBP ≥110 mm Hg, or both). We classified women according to the maximum blood pressure category reached across all visits for the primary analyses. The primary outcome was a maternal, fetal, or neonatal mortality or morbidity composite. We estimated dose-response relationships between blood pressure category and adverse outcomes, as well as diagnostic test properties.Between Nov 1, 2014, and Feb 28, 2017, 21 069 women (6067 in India, 4163 in Mozambique, and 10 839 in Pakistan) contributed 103 679 blood pressure measurements across the three CLIP trials. Only women with non-severe or severe stage 2 hypertension, as discrete diagnostic categories, experienced more adverse outcomes than women with normal blood pressure (risk ratios 1·29-5·88). Using blood pressure categories as diagnostic thresholds (women with blood pressure within the category or any higher category vs those with blood pressure in any lower category), dose-response relationships were observed between increasing thresholds and adverse outcomes, but likelihood ratios were informative only for severe stage 2 hypertension and maternal CNS events (likelihood ratio 6·36 [95% CI 3·65-11·07]) and perinatal death (5·07 [3·64-7·07]), particularly stillbirth (8·53 [5·63-12·92]).In low-resource settings, neither elevated blood pressure nor stage 1 hypertension were associated with maternal, fetal, or neonatal mortality or morbidity adverse composite outcomes. Only the threshold for severe stage 2 hypertension met diagnostic test performance standards. Current diagnostic thresholds for hypertension in pregnancy should be retained.University of British Columbia, the BillMelinda Gates Foundation.

Summary Background To overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes, we aimed to reduce all-cause adverse outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries. Methods In this individual participant-level meta-analysis, we de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014–17. Consenting pregnant women, aged 12–49 years, were recruited in their homes. Clusters, defined by local administrative units, were randomly assigned (1:1) to intervention or control groups. The control groups continued local standard of care. The intervention comprised community engagement and existing community health worker-led mobile health-supported early detection, initial treatment, and hospital referral of women with hypertension. For this meta-analysis, as for the original studies, the primary outcome was a composite of maternal or perinatal outcome (either maternal, fetal, or neonatal death, or severe morbidity for the mother or baby), assessed by unmasked trial surveillance personnel. For this analysis, we included all consenting participants who were followed up with completed pregnancies at trial end. We analysed the outcome data with multilevel modelling and present data with the summary statistic of adjusted odds ratios (ORs) with 95% CIs (fixed effects for maternal age, parity, maternal education, and random effects for country and cluster). This meta-analysis is registered with PROSPERO, CRD42018102564. Findings Overall, 44 clusters (69 330 pregnant women) were randomly assigned to intervention (22 clusters [36 008 pregnancies]) or control (22 clusters [33 322 pregnancies]) groups. 32 290 (89·7%) pregnancies in the intervention group and 29 698 (89·1%) in the control group were followed up successfully. Median maternal age of included women was 26 years (IQR 22–30). In the intervention clusters, 6990 group and 16 691 home-based community engagement sessions and 138 347 community health worker-led visits to 20 819 (57·8%) of 36 008 women (of whom 11 095 [53·3%] had a visit every 4 weeks) occurred. Blood pressure and dipstick proteinuria were assessed per protocol. Few women were eligible for methyldopa for severe hypertension (181 [1%] of 20 819) or intramuscular magnesium sulfate for pre-eclampsia (198 [1%]), of whom most accepted treatment (162 [89·5%] of 181 for severe hypertension and 133 [67·2%] of 198 for pre-eclampsia). 1255 (6%) were referred to a comprehensive emergency obstetric care facility, of whom 864 (82%) accepted the referral. The primary outcome was similar in the intervention (7871 [24%] of 32 290 pregnancies) and control clusters (6516 [22%] of 29 698; adjusted OR 1·17, 95% CI 0·90–1·51; p=0·24). No intervention-related serious adverse events occurred, and few adverse effects occurred after in-community treatment with methyldopa (one [2%] of 51; India only) and none occurred after in-community treatment with magnesium sulfate or during transport to facility. Interpretation The CLIP intervention did not reduce adverse pregnancy outcomes. Future community-level interventions should expand the community health worker workforce, assess general (rather than condition-specific) messaging, and include health system strengthening. Funding University of British Columbia, a grantee of the Bill & Melinda Gates Foundation.

The viability of orthodontic traction of impacted teeth in adults is often questioned by a large percentage of orthodontists who would rather consider the extraction of these teeth. Although possible, orthodontic traction of impacted canines in adults takes longer than in younger patients, present a poorer prognosis that worsens with age. Because of the prevalence of periodontitis in adults versus children, periodontal inflammation must be identified and resolved in order to keep attachment loss from progressing during orthodontic care. Likewise mucogingival changes need to be predicted and managed. This article reports a successful case of impacted maxillary right canine traction in an adult female, associated with alveolar corticotomies and the use of skeletal anchorage. At the end of treatment, the canine was ideally positioned in the occlusion, presenting excellent esthetics, function, and healthy periodontal tissues.

Alveolar corticotomy (ACO) is increasingly popular to accelerate orthodontic tooth movement. However, because it is an invasive surgical procedure, there is still some resistance to its use. Combining ACO with other surgical procedures is a means to employ the method without adding an additional surgical intervention. Combining surgical interventions into one surgery reduces trauma and down time for the patient and also allows clinicians to maximize treatment outcomes. This article illustrates how the anticipation of the 3rd molars extraction created a window of opportunity for the use of ACO and miniplates, to successfully and efficiently retreat a moderate skeletal Class II on a young adult patient who did not accept orthognathic surgery with orthodontics as a retreatment alternative.

The aim of this research was to test the viability of short wave near infrared spectroscopy (SW-NIRS) for the monitoring of fruit quality and ripening evolution in Algarve Citrus orchards (Citrus sinensis L. Osbeck ‘Newhall’). Specifically, we have investigated the robustness of SW-NIRS calibration models in real conditions, that is: i) measurements were performed on tree, at a single location in the fruit equator, in the sunlight and with no temperature equilibration; and ii) with validation through independent data obtained in different years and/or orchards. Calibration models for soluble solids content (SSC), juice pH, titratable acidity (TA), firmness and maturation index (MI = SSC/TA) were built from the spectral data obtained in two orchards with different edaphoclimatic conditions, and in two consecutive years, corresponding to four independent datasets. We propose a method to assess model robustness through the comparison of internal validation (IV: calibration and validation data sets homogeneously sampled from the whole data set) and external validation (EV: calibration and validation data sets corresponding to different orchards and/or years). The method is based on the statistics of the results obtained by either IV and EV when applied to all the possible combinations of the four datasets. The results show that IV overestimates the models’ performance relatively to the realistic exercise of EV. Globally, SSC and juice pH were the best performing models, with fair performances in IV and poor performances in EV (example for SSC: (IV/EV): rmsep = 1.00/1.15%, SDR = 1.40/1.13, R2 = 0.49/0.34). Firmness yielded the worse models, while TA and MI yielded intermediate performances. However, the plots derived from the comparison method suggest a convergence of IV and EV performances for larger numbers of samples, and thus the potential for future continuous model improvement.

Algarve Citrus are non-climacteric Protected Geographical Indication (PGI) commodities. They are harvested with minimal levels of juice content (>35 %), soluble solids content (SSC) (>10 %) and maturation index (MI) (>8), as required by the respective PGI normative reference. These internal quality attributes (IQA) are usually determined in small samples of fruit collected from the orchards close to harvest. This study aimed to use geostatistics to help predict the optimal harvest date (OHD) of two sweet orange (Citrus sinensis (L.) Osbeck) cultivars, namely, 'Newhall', and 'Valencia Late', at two different edaphoclimatic conditions observed in the locations of Quarteira, at the coast, and Paderne, near a mountainous area. Two orchards of 0.5-0.7 ha per cultivar were chosen and a total of 25 trees were georeferenced within each orchard, comprising 100 sampling points/trees. Firmness, juice content, SSC and MI of fruit were determined through time. In general, the fruit grown in Quarteira showed higher SSC and MI and lower firmness values, ripening two months earlier than those grown in Paderne, although the full effect of the various edaphoclimatic factors on these results are not fully understood. However, geospatial modelling of ripening has shown a large variability within the orchards, with some IQA evolution patterns observed in some orchards and/or cultivars but not in the others. Specifically, 1) a negative correlation between the firmness and MI spatial patterns; 2) a variable decay rate of firmness, much faster in Paderne for 'Valencia Late'; 3) local minima in juice content, below 35 %, observed in restricted spatial areas and in specific time periods, and which were clearer in 'Newhall'. These local variations highlight the need for an optimized management based on geospatial modelling. For example, the variable decay rate of firmness must be taken into account during fruit harvest and postharvest handling. On the other side, the observation of localized plots with juice content below 35 % must be contextualized in the broader picture of the entire orchard which, in the present study, always had consistent temporal average level above 35 %. This study has provided evidence that fruit ripening variability should be considered in the site-specific orchard management of citrus to optimize their harvest date. FCT - Fundacao para a Ciencia e a Tecnologia, PortugalPortuguese Foundation for Science and Technology [UID/Multi/00631/2013]; NIBAP: Nucleo de Investigacao em Biotecnologia e Agricultura de Precisao [ALG-01-0247-FEDER-037303]; FCT - Fundacao para a Ciencia e a TecnologiaPortuguese Foundation for Science and Technology [DL 57/2016/CP1361/CT0031] ALG-01-0247-FEDER-037303 info:eu-repo/semantics/publishedVersion

Halting biodiversity loss is one of the major conservation challenges of our time and science-based conservation actions are required to safeguard the survival of endangered species. However the establishment of effective conservation strategies may be hampered by inherent difficulties of studying elusive animals. We used analysis of control region sequences to obtain baseline information on the genetic diversity and population structure and history of the elusive and critically endangered Mediterranean monk seal that will help define an effective conservation strategy for the species. We analyzed 165 samples collected throughout the entire extant range of the species and identified 5 haplotypes. Based on levels of genetic diversity (haplotypic diversity: 0.03; variable sites: 0.6%) the Mediterranean monk seal appears to be one of the most genetically depauperate mammals on Earth. We identified three genetically distinct monk seal subpopulations: one in the north Atlantic [Cabo Blanco vs. Aegean Sea (FST = 0.733; P = 0.000); Cabo Blanco vs. Ionian Sea (FST = 0.925; P = 0.000)] and two in the Mediterranean, one in the Ionian and another one in the Aegean Sea (Ionian vs. Aegean Sea FST = 0.577; P = 0.000). Results indicate a recent divergence and short evolutionary history of the extant Mediterranean monk seal subpopulations. Based on the results we recommend continuation of the monitoring efforts for the species and systematic collection of genetic samples and storage in dedicated sample banks. On a management level we argue that, based on genetic evidence, it is justified to manage the Atlantic and Mediterranean monk seal subpopulations as two separate management units. In Greece, the existence of two subpopulations should guide efforts for the establishment of a network of protected areas and identify the monitoring of habitat availability and suitability as an important conservation priority.

The article examines the role of central government, regional plans and city plans which comprise the institutional framework for urban planning in Portugal. Particular attention is focused upon the strategic planning process adopted for Lisbon, currently being promoted by that municipality as the Atlantic capital of Europe. A number of strategic planning issues facing Lisbon are examined within the context of European urbanization, including urban growth, transport, housing, economic development and urban conservation/regeneration. The article assesses the current attempts by the city to implement a strategic plan for the capital, and comments on its future prospects. Considerable attention is currently focused upon Lisbon given its recent role as European City of Culture in 1994, and the urban regeneration initiatives associated with Expo 1998. Expo offers the possibility of improving and integrating the eastern side of the city with its central area and waterfront. The project is also linked to the construction of the new River Tagus bridge crossing. The article concludes that Lisbon has a clear sense of purpose and direction as a major European city

This paper questions the adequacy of the traditional approach to the study of agricultural pluriactivity which tends to be set within a narrow agricultural framework and assumes a descriptive nature. The basic argument is that an explanatory approach to contemporary forms of agricultural pluriactivity has to be informed by the process of capitalist restructuring and social change. This paper starts with a general analysis of the changing modes of the economic relations and then focuses on labour force reproduction structures. These are seen as most relevant in the context of a ‘semiperipheral’ society such as Portugal. It is concluded that although agricultural pluriactivity is clearly ‘rural’ in its origins, it contributes to, and gradually becomes part of, a wider process of change which transforms its very nature and blurs its original ‘rural’ boundaries.