Gabapentin is an anticonvulsant that has become a treatment option for several indications that are not approved by Health Canada. Commonly, gabapentin is prescribed for neuropathic pain and anxiety disorders. The objective of this dissertation was to evaluate the efficacy of gabapentin for reducing pre-operative anxiety, post-operative pain and opioid consumption. The initial study examined regimens of pre-operative and post-operative gabapentin given to patients undergoing total knee arthroplasty. Patients that received gabapentin postoperatively used significantly less morphine at 24 hrs, 36 hrs and 48 hrs (p<0.05). Furthermore these patients had significantly better active-assisted knee flexion on postoperative day (POD) 2, POD 3, with a trend toward better flexion on POD 4. Next, we examined whether: 1) gabapentin administration reduces pain and opioid use after total hip arthroplasty using a multimodal analgesic regimen that included spinal anesthesia; and whether 2) preoperative administration of gabapentin is more effective than postoperative administration. Our results demonstrated that whether a 600 mg dose of gabapentin was given preoperatively or postoperatively, patients’ postoperative morphine consumption or pain scores were not reduced in hospital nor was there a reduction in pain 6 months after hip arthroplasty. The third study found that a single dose of 600 mg of gabapentin was not sufficient to reduce preoperative anxiety in patients prior to hip arthroplasty. In contrast, the final study demonstrated that 1200mg of gabapentin reduced pre-operative anxiety and pain catastrophizing in female patients with moderate to high levels of preoperative anxiety prior to major surgery, but also increased preoperative and early postoperative sedation. Our findings demonstrate the efficacy of perioperative gabapentin with respect to preoperative anxiety reduction and decreasing morphine consumption after surgery. Future studies that focus on the optimal dose and duration of perioperative gabapentin, with the aim of improving functional outcomes and decreasing the incidence and severity chronic post-surgical pain are warranted.

Agriculture is arguably the greatest threat to tropical forest species. Conservation scientists disagree over the relative importance of two opposing strategies for minimising this threat: enhancing on-farm biodiversity, through wildlife-friendly farming practices, or sparing land for nature by using high-yielding farming methods on the smallest possible area to reduce the need to convert natural habitats. Previous theoretical work shows that understanding the relationship between population density and yield for individual species is crucial for determining whether one of these strategies, or a mixed strategy, will maximise their populations for a given food production target. In this thesis, I aim to identify what land-use strategy will permit increases in food production with least impact on species in the forest zone of Ghana. Farm-fallow mosaic landscapes with shifting cultivation and native canopy trees produced only around 15% as much food energy per hectare as the highest-yielding oil palm plantations. In farm mosaics where perennial tree crops dominate, food production and profits were higher, but did not reach those of oil palm plantations. I surveyed birds and trees in forest, farm mosaic, and oil palm plantation, and combined these data with information on yields to assess the likely consequences of plausible future scenarios of land-use change. My results provide evidence of a strong trade-off between wildlife value and agricultural yield. Species richness was high in low-yielding farming systems, but there was considerable turnover between these systems and forests, with widespread generalists replacing narrowly endemic forest-dependent species. Species most dependent on forest as a natural habitat, those with smaller global ranges and those of conservation concern showed least tolerance of habitat modification. For virtually all species, including even widespread generalists, future land-use strategies based on land sparing are likely to support higher populations of most species and minimise their risk of extinction compared to land-use strategies based on wildlife-friendly farming. If food production is to increase in line with Ghana‘s population growth, a combination of efforts to improve forest protection and to increase yields on current farmed land is likely to achieve this at least cost to forest species. Efforts to better protect forests, which require further restrictions on human use, might be most effective if they can be closely linked to support for farmers to improve their yields. In the long term however, this strategy will only delay and not avert biodiversity loss, unless global society can limit its consumption.

A large amount of the world’s biodiversity is located in a disproportionately small amount of area, namely the tropics. Many of these areas are experiencing rapid landscape changes, mainly in the form of deforestation for agricultural practices. Current conservation efforts are focused on agricultural areas and their ability to provide habitat. The conservation value of a novel land-sparing agroforestry system, known as Integrated Open Canopy (IOC), was recently demonstrated on the study site when applied to coffee. IOC coffee supports forest species that are uncommon or absent in shade grown coffee. I generated best management practices for IOC farms relative to the conservation of forest-dependent birds by examining what features support the highest richness of species. The goal was to help develop guidelines for the implementation of IOC grown coffee. The Golden-winged warbler (Vermivora chrysoptera) is a Neartic-Neotropical migrant of high conservation priority which has been documented using a range of nonbreeding habitat types, including IOC coffee farms. However, as is the case with many migrant species, little is known about whether survival differs among habitats. Though generally forest dependent, previous work found Golden-winged warblers select for habitat features other than categorical forest types, such as canopy height and microhabitat features. In an attempt to identify quality nonbreeding habitat, I estimated Golden-winged survival rates specific to an array of habitat features.

Magister Pharmaceuticae - MPharm / Antimicrobial resistance is a global concern associated with increased morbidity and mortality. It has been estimated that, by 2050, the continuous escalation of antimicrobial resistance, globally, will result in more deaths per year, compared to cancer and diabetes. The direct and indirect impact of ineffective antibiotics, and therefore, antimicrobial resistance, will be hardest felt by low and middle-income countries, as the financial burden will be too great to manage. Carbapenems are considered the last line of antimicrobials to treat multidrug-resistant bacterial infections. They are the preferred choice to treat infections, presenting with extended-spectrum beta-lactamases (ESBL) producing Enterobacteriacea. Various strains of bacteria that have become resistant, due to the selective pressure, as a result of carbapenem over use, are referred to as Carbapenem-resistant Enterobacteriaceae (CRE). / 2022

The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the reference list of the included studies. Nerve-sparing techniques can be distinguished based on the fascial planes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde or antegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release), the use of cautery, the application of traction and the number of the neurovascular bundles which are preserved. Despite this rough categorisation, many techniques have been developed which cannot be integrated in one of the categories described above. Moreover, emerging technologies have entered the nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximal extent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization of the correct planes remain the basic principles for achieving optimum functional outcomes. Given that potency and continence outcomes after radical prostatectomy are multifactorial endpoints in addition to the difficulty in their postoperative assessment and the well-documented discrepancy existing in their definition, safe conclusions about the superiority of one technique over the other cannot be easily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary.

Current treatments for obesity have been unsuccessful. It is essential that a patient-centred approach for obesity management is developed and for this to be successful other diet and lifestyle approaches need to be considered. A systematic review comparing low carbohydrate vs. low fat diets for the treatment of obesity was carried out. It found that low carbohydrate/high protein diets are as effective as, if not better, for treating obesity and cardiovascular disease risk factors. A randomised controlled trial investigating dietary approaches for the treatment of obesity and its co morbidities was carried out. Variables including weight and body composition, cardiovascular risk factors, adipokines, liver and kidney function, and health and lifestyle factors were measured. Those with metabolic syndrome were also examined. It was hypothesised that there are alternative ways of treating obese subjects depending on their phenotype. Those with a higher BMI tend to have a higher carbohydrate intake rather that a higher fat intake so may be better suited to a low carbohydrate/high protein diet rather than the conventional low fat/energy reduced diet. Subjects were initially treated with the standard dietary approach for obesity (health eating, HE) and if not successful after 3 months were randomised to either a very low calorie diet (Lighterlife, LL) or a protein sparing modified fast (PSMF). All three groups showed a significant weight loss and reduced risk for CVD at 12 months. Significant improvements were seen for plasminogen-activated receptor-1, adiponectin, leptin and IL-6 on HE and LL, but only adiponectin significantly improved on the PSMF. Neither diet showed any detrimental effects for those with a healthy liver and kidney function. Quality of life and levels of depression improved at 12 months. Of the 54 subjects with metabolic syndrome at baseline, 12 remained on HE and 32 were randomised to LL and PSMF. This indicates that most subjects did not suit a low fat dietary approach. They were successful at losing weight on LL and PSMF and showed improvement in MS risk factors, and adipokine levels at 12 months. In conclusion, the study demonstrates that a low fat diet may not necessarily be the first line of approach to treat obese subjects with a BMI over 35 kg/m2, including those with MS. A very low calorie diet such as LL or a PSMF may be better suited to the subject.

O presente estudo visa comparar biomecanicamente, por meio do ensaio de flexão em quatro pontos, a resistência de segmentos de rádios de cães autoclavados e desvitalizados em nitrogênio líquido. Foram utilizados 20 cadáveres de cães de mais de dois anos de idade e massa corporal superior a 20 kg, portanto 40 rádios, que foram divididos em quatro grupos: grupo autoclave (GA), grupo controle autoclave (GCA), grupo nitrogênio (GN) e grupo controle nitrogênio (GCN). Os corpos de prova dos grupos GCA e GCN pertenciam ao lado contralateral dos grupos GA e GN, respectivamente. Os ossos foram autoclavados a 121&ordm;C, por 20 min a 2 atm. A desvitalização em nitrogênio foi realizada por meio da imersão em nitrogênio líquido, por 20 min, seguida de descongelamento à temperatura ambiente, sendo finalizada por imersão em solução de NaCL a 0,9%, por mais 15 min. A avaliação da resistência biomecânica foi realizada pelo ensaio de flexão em quatro pontos. Foi utilizado o programa de computador PMI para calcular o momento de inércia após o ensaio biomecânico destrutivo. Foram comparadas as variáveis força máxima, rigidez, altura máxima à secção transversa do corpo de prova, deslocamento do baricentro em relação ao eixo x, flecha, tensão-tração, tensão compressão e tensão máxima. Não foram encontradas diferenças estatisticamente significantes entre os grupos GN e GCN. Foram encontradas diferenças estatisticamente significantes entre os grupos GA e GCA somente na comparação da variável força máxima. A análise das variáveis tensão-tração, tensão-compressão e tensão máxima evidenciou diferenças estatisticamente significantes entre os grupos GA e GN, sendo os valores maiores para o grupo GA. Também foi realizada comparação entre os deltas (GN menos GCN e GA menos GCA) em que não foram observadas diferenças estatísticas. / The present study aim to, biomechanically compare through the four points bending test, the strenght of autoclaved and devitalized in liquid nitrogen radius segments. 20 corpses of dogs (>2 years of age and >20 kg of weight) were used. 40 radius were collected and divided into 4 groups, Autoclave Group (GA), Control Autoclave Group (GCA), Nitrogen Group (NG) and Control Nitrogen Group (GCN). Bone segments from groups GCA and GCN were contralateral to GA and NG. The segments were autoclaved at 121&ordm;C and 2 atm for 20 minutes. Nitrogen devitalization of the bone segments was obtained by 20 minutes immersion, followed by thawing at room temperature and 15 minutes immersion in 0,9% NaCL solution. The biomechanical strenght evaluation was performed in the four points bending test; afterwards, PMI computer program calculated the moment of inertia after the destructive biomechanical assay. Variables compared were maximum strength, stiffness, maximum high trough the transverse section of the bone segment, centers of mass dislocation in relation to x axe, arrow, stress-tension, stress-compression and maximum stress. No statistically significant differences between the GN and GCN groups were found. Statistically significant differences were found between groups GA and GCA only in the comparison of the maximum force variable. The analysis of variable stress-tension, stress-compression and maximum stress showed statistically significant differences between the GA and GN groups, with higher values for the GA group. Comparison of the deltas (GN least GCN and GA least GCA) that no statistical differences were observed was also performed.

Syftet med uppsatsen är att undersöka om och varför Sverige bör ingå skatteavtal med afrikanska utvecklingsländer. Sverige är medlem i OECD och har en lång tradition av skatteavtal framför allt gentemot andra industrialiserade länder. Afrikanska utvecklingsländer däremot har inte ett lika utvecklat skattesystem eller konkurrenskraftigt skatteavtalsnät och har andra förutsättningar än Sverige på den globala marknaden. Frågan om varför skatteavtal behövs mellan Sverige och afrikanska u-länder ska belysas genom dessa två vitt skilda perspektiv och utgångspunkter. Jag ifrågasätter även vilka incitament afrikanska stater har för att ingå skatteavtal med Sverige. För ytterligare vetenskaplig förankring har jag valt att granska tre av Sveriges skatteavtal med afrikanska länder. Hur förhåller sig de utvalda skatteavtalen i förhållande till FN:s modellavtal och vilka konsekvenser innebär detta för avtalen mellan Sverige och de utvalda afrikanska länderna? Förhoppningen är att uppsatsen ska bidra till att ge handlingsdirektiv för hur Sverige borde agera i frågan om skatteavtal gentemot afrikanska utvecklingsländer.

O presente estudo visa comparar biomecanicamente, por meio do ensaio de flexão em quatro pontos, a resistência de segmentos de rádios de cães autoclavados e desvitalizados em nitrogênio líquido. Foram utilizados 20 cadáveres de cães de mais de dois anos de idade e massa corporal superior a 20 kg, portanto 40 rádios, que foram divididos em quatro grupos: grupo autoclave (GA), grupo controle autoclave (GCA), grupo nitrogênio (GN) e grupo controle nitrogênio (GCN). Os corpos de prova dos grupos GCA e GCN pertenciam ao lado contralateral dos grupos GA e GN, respectivamente. Os ossos foram autoclavados a 121&ordm;C, por 20 min a 2 atm. A desvitalização em nitrogênio foi realizada por meio da imersão em nitrogênio líquido, por 20 min, seguida de descongelamento à temperatura ambiente, sendo finalizada por imersão em solução de NaCL a 0,9%, por mais 15 min. A avaliação da resistência biomecânica foi realizada pelo ensaio de flexão em quatro pontos. Foi utilizado o programa de computador PMI para calcular o momento de inércia após o ensaio biomecânico destrutivo. Foram comparadas as variáveis força máxima, rigidez, altura máxima à secção transversa do corpo de prova, deslocamento do baricentro em relação ao eixo x, flecha, tensão-tração, tensão compressão e tensão máxima. Não foram encontradas diferenças estatisticamente significantes entre os grupos GN e GCN. Foram encontradas diferenças estatisticamente significantes entre os grupos GA e GCA somente na comparação da variável força máxima. A análise das variáveis tensão-tração, tensão-compressão e tensão máxima evidenciou diferenças estatisticamente significantes entre os grupos GA e GN, sendo os valores maiores para o grupo GA. Também foi realizada comparação entre os deltas (GN menos GCN e GA menos GCA) em que não foram observadas diferenças estatísticas. / The present study aim to, biomechanically compare through the four points bending test, the strenght of autoclaved and devitalized in liquid nitrogen radius segments. 20 corpses of dogs (>2 years of age and >20 kg of weight) were used. 40 radius were collected and divided into 4 groups, Autoclave Group (GA), Control Autoclave Group (GCA), Nitrogen Group (NG) and Control Nitrogen Group (GCN). Bone segments from groups GCA and GCN were contralateral to GA and NG. The segments were autoclaved at 121&ordm;C and 2 atm for 20 minutes. Nitrogen devitalization of the bone segments was obtained by 20 minutes immersion, followed by thawing at room temperature and 15 minutes immersion in 0,9% NaCL solution. The biomechanical strenght evaluation was performed in the four points bending test; afterwards, PMI computer program calculated the moment of inertia after the destructive biomechanical assay. Variables compared were maximum strength, stiffness, maximum high trough the transverse section of the bone segment, centers of mass dislocation in relation to x axe, arrow, stress-tension, stress-compression and maximum stress. No statistically significant differences between the GN and GCN groups were found. Statistically significant differences were found between groups GA and GCA only in the comparison of the maximum force variable. The analysis of variable stress-tension, stress-compression and maximum stress showed statistically significant differences between the GA and GN groups, with higher values for the GA group. Comparison of the deltas (GN least GCN and GA least GCA) that no statistical differences were observed was also performed.

Este estudo tem por escopo analisar o conceito das cláusulas de tax sparing e matching credit, os principais argumentos favoráveis e contrários à utilização desses mecanismos e as hipóteses em que tais cláusulas são adotadas, nos âmbitos nacional e internacional. Sabe-se que, em um primeiro momento, a Organização para a Cooperação e Desenvolvimento Econômico (OCDE) chegou a recomendar a utilização das cláusulas de tax sparing nos acordos de bitributação celebrados entre países com graus diferentes de desenvolvimento econômico, como uma forma de atrair investimentos para os países menos desenvolvidos. No entanto, em relatório publicado em 1998, denominado Tax sparing: a reconsideration, a OCDE reviu sua posição inicial sobre o assunto, passando então a desencorajar o uso dessas cláusulas por seus países membros, através de diversas críticas e questionamentos acerca de sua adoção. O Brasil, por sua vez, desde os primeiros acordos de bitributação celebrados, nos primórdios da década de 1960, tem firmado a política de sempre negociar cláusulas de tax sparing e matching credit, especialmente nos acordos celebrados com países desenvolvidos. Considerando-se tal cenário, pretende-se, com o presente trabalho, estudar as cláusulas de tax sparing e matching credit de forma profunda, de modo a oferecer subsídios para um adequado enfrentamento da questão em futuras negociações de acordos de bitributação pelo País. / The purpose of this study is to analyze the concept of tax sparing and matching credit clauses, the main arguments for and against the use of these mechanisms and the circumstances in which such clauses are adopted, nationally and internationally. It is known that, at first, the Organisation for Economic Co-operation and Development (OECD) used to recommend the inclusion of tax sparing clauses in double taxation conventions concluded between countries with different levels of economic development, as a way of attracting investments for less developed countries. However, the OECD revised its initial position on the subject in a report published in 1998, called \"Tax sparing: a reconsideration\", discouraging the use of such clauses by its member countries through various criticisms and questions about their adoption. In its turn, since the first double taxation agreements concluded in the early 1960s the Brazilian policy regarding the matter has always been to negotiate tax sparing and matching credit clauses, especially in conventions with developed countries. Given such a scenario, this paper aims at studying tax sparing and matching credit clauses deeply, in order to provide devices for an accurate understanding of the issue in future negotiations of double taxation conventions by the Country.