Brazil in Africa: Another Emerging Power in the Continent?

This paper develops three basic arguments. First, it presents the basic underpinnings of Brazilian diplomacy in the past half century, concentrating on the changes adopted in the 1980s and the 1990s up to the foreign policy put forward by Lula`s government (2003-2009). It recognises that Lula`s foreign policy represents a step forward, especially where Africa is concerned. However, it does not seem to be clear whether the Brazilian economy has enough strength to sustain such a foreign policy, as is shown in the second part of the paper. This is indeed the case if comparisons are made with India, China and even South Africa, when the latter`s regional role is considered. Finally, an effort is made to summarise the recent political cooperation established between Brazil and African countries as well as to present an overview of Brazil`s trade and investment relations both with the region as a whole and with some important individual partners. Once this picture is established, we investigate whether these realmsdiplomatic/political and economictake independent tracks, or if they do interact in a coherent manner. Africa remained deep inside Brazil and Brazilians, not as something external to ourselves. But as a mythic space; neither geographical, nor historical.

From the terrible loneliness to the wonderful agreement of human beings

What would be the ""terrible loneliness"" and what would be the ""wonderful agreement"" in the present paper? The ""terrible loneliness"" is the only reality that a person perceives and/or thinks during the now going on. For the person, an enormous quantity of occurrences is in the present moment absent. A very small quantity of occurrences is present. The person is the only being in having this. And, this is only during a little moment. The person never thinks about his loneliness in this moment. On the contrary, he thinks he is plenty of people and full of occurrences. But, if he were thinking about reality, he would live in a terrible loneliness. How does he escape himself from this loneliness? He thinks that the probable occurrences are real occurrences. He may be right in a plenty of times. Going through what I call opening hypotheses-basic hypotheses and non-basic but important hypotheses-and going through what I call simply hypotheses he is able to sanction a wonderful agreement of human beings about the known parts of the Universe. However, they are hypotheses, not absolute realities.

Two important but almost never related beliefs

Engelmann believes in two general strong beliefs. On one side, Engelmann believes in probabilistic skepticism. That the existence has its maximum probability or there is no existence at all is not possible. The other probabilities of existence are always possible. On the other hand, instead of elements that constitute a beginning arrived at by an unknown division, the Gestalt theory begins with wholes or Gestalten. These Gestalten can be divided in parts but each part can be only a part of his specific Gestalt. The majority of probabilistic skeptics and the majority of Gestalt theory followers do not believe they can be together accepted. On the contrary Engelmann is a member of a small group that both beliefs occur simultaneously. Bibace`s questions were each answered by Engelmann. In some questions Engelmann harmonize with Bibace, in others they disagree.

Super-ego: ego tenant

The process of metapsychologic concepts development in Freud`s works is not linear; on the contrary, it oscillates, with comings and goings, temporary abandonments, ambiguities, contradictions. Within key metapsychology concepts, the concept of superego is certainly complex and troublesome, for not only it holds many definitions but its scope is also wide. From clinic to metapsychology, going across the theory of culture, the superego plays a role in all aspects of psychoanalytic investigation, misunderstandings appearing quite frequently, therefore, among those who comment it. In addition to it, Freud himself was no faithful historian of his own concepts. The present paper proposes to undo a few ambiguities in what concerns the evolution process of ego conception, beginning from a fundamental metapsychologic problem, which is the remake of the notion of ego. We support that changes in the ego theory were crucial to the elaboration of conceptual basis of super-ego in its legislative function. We will see that the super-ego begins its story as a discreet tenant to the ego to become tyrannical and usurper, threatening the ego integrity.

Comunicação e ação política no contínuo mediático: Luhmann contra Habermas. E nós contra todos

A política para Jürgen Habermas se faz com a formação de consciências e com o investimento na linguagem, no falar cotidiano, na relação intersubjetiva. Já para Niklas Luhmann, a política se faz por si mesma, e a opinião pública não tem relação com a opinião pessoal. Não adianta investir na linguagem, porque ela é pré-social, está além dos sujeitos, nenhuma democratização pode sair daí. Mas as propostas dos dois pensadores mostram-se insuficientes para a atualidade, com suas altas tecnologias comunicacionais, pois nenhum dos modelos dá uma resposta animadora para a questão das redes, nenhuma delas visualiza um espaço mediático próprio fazendo a mediação dos sistemas, nenhuma delas dá elementos para a construção de uma teoria da comunicação tecnologicamente avançada.

Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital

OBJECTIVES: To describe noninvasive positive-pressure ventilation use in intensive care unit clinical practice, factors associated with NPPV failure and the associated prognosis. METHODS: A prospective cohort study. RESULTS: Medical disorders (59%) and elective surgery (21%) were the main causes for admission to the intensive care unit. The main indications for the initiation of noninvasive positive-pressure ventilation were the following: post-extubation, acute respiratory failure and use as an adjunctive technique to chest physiotherapy. The noninvasive positive-pressure ventilation failure group was older and had a higher Simplified Acute Physiology Score II score. The noninvasive positive-pressure ventilation failure rate was 35%. The main reasons for intubation were acute respiratory failure (55%) and a decreased level of consciousness (20%). The noninvasive positive-pressure ventilation failure group presented a shorter period of noninvasive positive-pressure ventilation use than the successful group [three (2-5) versus four (3-7) days]; they had lower levels of pH, HCO3 and base excess, and the FiO(2) level was higher. These patients also presented lower PaO2:FiO2 ratios; on the last day of support, the inspiratory positive airway pressure and expiratory positive airway pressure were higher. The failure group also had a longer average duration of stay in the intensive care unit [17 (10-26) days vs. 8 (5-14) days], as well as a higher mortality rate (9 vs. 51%). There was an association between failure and mortality, which had an odds ratio (95% CI) of 10.6 (5.93 - 19.07). The multiple logistic regression analysis using noninvasive positive pressure ventilation failure as a dependent variable found that treatment tended to fail in patients with a Simplified Acute Physiology Score II >= 34, an inspiratory positive airway pressure level >= 15 cmH2O and pH<7.40. CONCLUSION: The indications for noninvasive positive-pressure ventilation were quite varied. The failure group had a longer intensive care unit stay and higher mortality. Simplified Acute Physiology Score II >= 34, pH<7.40 and higher inspiratory positive airway pressure levels were associated with failure.

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that should be considered due to the frequent occurrence of aspiration pneumonia that could influence the patient's recovery as it causes clinical complications and could even lead to the patient's death. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. This study aimed to create an algorithm to identify patients at risk of developing dysphagia following acute ischemic stroke in order to be able to decide on the safest way of feeding and minimize the complications of stroke using the National Institutes of Health Stroke Scale (NHISS). Methods: Clinical assessment of swallowing was performed in 50 patients admitted to the emergency unit of the University Hospital, Faculty of Medicine of Ribeirao Preto, Sao Paulo, Brazil, with a diagnosis of ischemic stroke, within 48 h after the beginning of symptoms. Patients, 25 females and 25 males with a mean age of 64.90 years (range 26-91 years), were evaluated consecutively. An anamnesis was taken before the patient's participation in the study in order to exclude a prior history of deglutition difficulties. For the functional assessment of swallowing, three food consistencies were used, i.e. pasty, liquid and solid. After clinical evaluation, we concluded whether there was dysphagia. For statistical analysis we used the Fisher exact test, verifying the association between the variables. To assess whether the NIHSS score characterizes a risk factor for dysphagia, a receiver operational characteristics curve was constructed to obtain characteristics for sensitivity and specificity. Results: Dysphagia was present in 32% of the patients. The clinical evaluation is a reliable method of detection of swallowing difficulties. However, the predictors of risk for the swallowing function must be balanced, and the level of consciousness and the presence of preexisting comorbidities should be considered. Gender, age and cerebral hemisphere involved were not significantly associated with the presence of dysphagia. NIHSS, Glasgow Coma Scale, and speech and language changes had a statistically significant predictive value for the presence of dysphagia. Conclusions: The NIHSS is highly sensitive (88%) and specific (85%) in detecting dysphagia; a score of 12 may be considered as the cutoff value. The creation of an algorithm to detect dysphagia in acute ischemic stroke appears to be useful in selecting the optimal feeding route while awaiting a specialized evaluation. Copyright (C) 2012 S. Karger AG, Basel

Morphometric endoscopic study of the pharynx in patients with sleep apnea

Purpose: The aims of the study were to measure endoscopically the retrolingual pharynx during wakefulness and sleep before and after maxillomandibular advancement surgery and to quantify the changes observed. Materials and Methods: Eighteen patients with mild to severe grade obstructive sleep apnea hypopnea were evaluated during wakefulness while sitting and lying down and during induced sleep in dorsal decubitus while breathing naturally. Images of the retrolingual region of the pharynx were captured with a nasofibroscope and recorded on a DVD using the Sony Vegas 8.0 software (Sony Creative Software, Madison, WI). The images captured in greater and smaller aperture were measured with the Image J software (produced by Wayne Rasband, United States National Institutes of Health, Bethesda, MD) in linear anteroposterior and linear laterolateral areas. A correction factor was then applied to equalize the size of the images and thus compare them to one another. Results: The postoperative dimensions of the pharynx always increased significantly in all measurements compared with the preoperative ones. During induced sleep in dorsal decubitus, there was a greater gain in the area of smaller aperture (201.33%). Conclusions: The proposed method showed that the dimensions of the pharynx always increased significantly after surgery for maxillomandibular advancement, although the gain was not homogeneous in all dimensions and also varied according to state of consciousness. The greatest gain was observed in the area of smaller aperture with the patient in induced sleep, thus reducing the collapse of the pharynx. (C) 2012 Elsevier Inc. All rights reserved.

Post-conventional Political Cultures via Processes of Direct Democracy: Theoretical Considerations Based on Jurgen Habermas and Lawrence Kohlberg

In this article, it is proposed to differentiate political cultures in two dimensions. First, inspired by Habermas' distinction of the contents of discourse, a distinction is suggested between moral, ethical-political and pragmatic elements of political culture as well as of an element of culture of balancing interests. Second, inspired by Kohlberg's stage models for the development of the individual moral consciousness and for moral culture, a distinction is similarly suggested between two pre-conventional, two conventional and two post-conventional collective stages of political culture. It can be shown that from a normative point of view, only deliberations made in a post-conventional political culture can produce reasonable or at least fair results. Conceptual considerations indicate processes of direct democracy as the method for promoting post-conventional political cultures. The more liberty that the citizens have to formulate and trigger processes of direct democracy, the more one can expect from them to generate post-conventional political cultures.

A graph-theoretical approach in brain functional networks. Possible implications in EEG studies

Abstract Background Recently, it was realized that the functional connectivity networks estimated from actual brain-imaging technologies (MEG, fMRI and EEG) can be analyzed by means of the graph theory, that is a mathematical representation of a network, which is essentially reduced to nodes and connections between them. Methods We used high-resolution EEG technology to enhance the poor spatial information of the EEG activity on the scalp and it gives a measure of the electrical activity on the cortical surface. Afterwards, we used the Directed Transfer Function (DTF) that is a multivariate spectral measure for the estimation of the directional influences between any given pair of channels in a multivariate dataset. Finally, a graph theoretical approach was used to model the brain networks as graphs. These methods were used to analyze the structure of cortical connectivity during the attempt to move a paralyzed limb in a group (N=5) of spinal cord injured patients and during the movement execution in a group (N=5) of healthy subjects. Results Analysis performed on the cortical networks estimated from the group of normal and SCI patients revealed that both groups present few nodes with a high out-degree value (i.e. outgoing links). This property is valid in the networks estimated for all the frequency bands investigated. In particular, cingulate motor areas (CMAs) ROIs act as ‘‘hubs’’ for the outflow of information in both groups, SCI and healthy. Results also suggest that spinal cord injuries affect the functional architecture of the cortical network sub-serving the volition of motor acts mainly in its local feature property. In particular, a higher local efficiency El can be observed in the SCI patients for three frequency bands, theta (3-6 Hz), alpha (7-12 Hz) and beta (13-29 Hz). By taking into account all the possible pathways between different ROI couples, we were able to separate clearly the network properties of the SCI group from the CTRL group. In particular, we report a sort of compensatory mechanism in the SCI patients for the Theta (3-6 Hz) frequency band, indicating a higher level of “activation” Ω within the cortical network during the motor task. The activation index is directly related to diffusion, a type of dynamics that underlies several biological systems including possible spreading of neuronal activation across several cortical regions. Conclusions The present study aims at demonstrating the possible applications of graph theoretical approaches in the analyses of brain functional connectivity from EEG signals. In particular, the methodological aspects of the i) cortical activity from scalp EEG signals, ii) functional connectivity estimations iii) graph theoretical indexes are emphasized in the present paper to show their impact in a real application.

Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

DKA is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones (catecholamines, glucagon, cortisol, growth hormone). The biochemical criteria for diagnosis are: blood glucose > 200 mg/dl, venous pH <7.3 or bicarbonate <15 mEq/L, ketonemia >3 mmol/L and presence of ketonuria. A patient with DKA must be managed in an emergency ward by an experienced staff or in an intensive care unit (ICU), in order to provide an intensive monitoring of the vital and neurological signs, and of the patient's clinical and biochemical response to treatment. DKA treatment guidelines include: restoration of circulating volume and electrolyte replacement; correction of insulin deficiency aiming at the resolution of metabolic acidosis and ketosis; reduction of risk of cerebral edema; avoidance of other complications of therapy (hypoglycemia, hypokalemia, hyperkalemia, hyperchloremic acidosis); identification and treatment of precipitating events. In Brazil, there are few pediatric ICU beds in public hospitals, so an alternative protocol was designed to abbreviate the time on intravenous infusion lines in order to facilitate DKA management in general emergency wards. The main differences between this protocol and the international guidelines are: intravenous fluid will be stopped when oral fluids are well tolerated and total deficit will be replaced orally; if potassium analysis still indicate need for replacement, it will be given orally; subcutaneous rapid-acting insulin analog is administered at 0.15 U/kg dose every 2-3 hours until resolution of metabolic acidosis; approximately 12 hours after treatment initiation, intermediate-acting (NPH) insulin is initiated at the dose of 0.6-1 U/kg/day, and it will be lowered to 0.4-0.7 U/kg/day at discharge from hospital.

Risk factors for swallowing dysfunction in stroke patients

CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.

Diálogo no limiar e diatribe: mecanismos de construção da autoconsciência do sujeito

Este artigo tem o objetivo de refletir sobre o diálogo no limiar, um gênero nascido do diálogo socrático, e a diatribe, um gênero retórico interno dialogado, compreendidos ambos os fenômenos, neste estudo, como instrumentos privilegiados para a construção da autoconsciência do protagonista de Uma criatura dócil, novela de Dostoiévski. Tencionamos examinar, na materialidade do texto, o partejar das ideias desenvolvido pelo diálogo no limiar no momento da crise existencial vivida pela personagem-narrador e os expedientes da diatribe que provocam a experimentação filosófico-dialógica que esse sujeito assume ao constituir a sua voz.

A arquitetura patrimonial através dos jogos digitais

O presente artigo pretende ressaltar o potencial dos jogos digitais como instrumento de assimilação do conhecimento em arquitetura patrimonial, através da pesquisa Patrimônio arquitetônico, design e educação: desenvolvimento de Sistemas Interativos Lúdicos (jogos educativos em meio digital). Nesta pesquisa foram desenvolvidos jogos digitais a partir do levantamento das características arquitetônicas dos edifícios de relevância histórica e cultural da cidade de São Carlos. Através da interação e exploração da interface digital pelo usuário, a apropriação do conhecimento ocorre de uma forma lúdica e criativa. Por meio da manipulação desses jogos, os alunos, cidadãos e visitantes podem aproximar-se da educação patrimonial adquirindo consciência histórica e aprendendo a valorizar as origens da cidade e a arquitetura do município. Ressalta-se a importância das metodologias que permitem viabilizar o desenvolvimento dos jogos eletrônicos (desenho e linguagem de programação) e que se apresentam como importantes ferramentas de representação da arquitetura. Por fim, destaca-se a importância da educação patrimonial para a formação do cidadão e preservação do patrimônio cultural.

Bias and learning in temporal binding: intervals between actions and outcomes are compressed by prior bias

It has consistently been shown that agents judge the intervals between their actions and outcomes as compressed in time, an effect named intentional binding. In the present work, we investigated whether this effect is result of prior bias volunteers have about the timing of the consequences of their actions, or if it is due to learning that occurs during the experimental session. Volunteers made temporal estimates of the interval between their action and target onset (Action conditions), or between two events (No-Action conditions). Our results show that temporal estimates become shorter throughout each experimental block in both conditions. Moreover, we found that observers judged intervals between action and outcomes as shorter even in very early trials of each block. To quantify the decrease of temporal judgments in experimental blocks, exponential functions were fitted to participants’ temporal judgments. The fitted parameters suggest that observers had different prior biases as to intervals between events in which action was involved. These findings suggest that prior bias might play a more important role in this effect than calibration-type learning processes.