Razão e desrazão nas tomadas de decisão

Tal como se apresenta na atualidade, o campo de Teorias de Tomadas de Decisão reflete a intersecção de três desenvolvimentos teóricos principais: Utilidade Esperada, Heurísticas e Desvios e Intuição Holística. As relações entre estes não são clarividentes, nem estão estabelecidas na literatura sobre o assunto, sobretudo porque algumas das tendências em jogo ainda são muito novas. Meu objetivo é contribuir para o suprimento desta lacuna, oferecendo uma visão geral do campo, particularmente sensível às demandas epistemológicas às quais cada novo desenvolvimento respondeu e às limitações destas respostas. De especial interesse é o fato de que isto irá habilitar o leitor a compreender os fundamentos do novo conceito de intuição decisional que desponta e a se posicionar criticamente em relação ao mesmo.

Quadruple therapy with furazolidone for retreatment in patients with peptic ulcer disease

AIM: To establish the efficacy and safety of a 7-d therapeutic regimen using omeprazole, bismuth suticitrate, furazolidone and amoxicillin in patients with peptic ulcer disease who had been previously treated with other therapeutic regimens without success. METHODS: Open cohort study which included patients with peptic ulcer who had previously been treated unsuccessfully with one or more eradication regimens. The therapeutic regimen consisted of 20 mg omeprazole, 240 mg colloidal bismuth subcitrate, 1000 mg amoxicillin, and 200 mg furazolidone, taken twice a day for 7 d. Patients were considered as eradicated when samples taken from the gastric antrum and corpus 12 wk after the end of treatment were negative for Helicobacter pylori (H pylori) (rapid urease test and histology). Safety was determined by the presence of adverse effects. RESULTS: Fifty-one patients were enrolled. The eradication rate was 68.8% (31/45). Adverse effects were reported by 31.4% of the patients, and these were usually considered to be slight or moderate in the majority of the cases. Three patients had to withdraw from the treatment due to the presence of severe adverse effects. CONCLUSION: The association of bismuth, furazolidone, amoxicillin and a proton-pump inhibitor is a valuable alternative for patients who failed to respond to other eradication regimens. It is an effective, cheap and safe option for salvage therapy of positive patients. (C) 2008 The WJG Press. All rights reserved.

Short-term triple therapy with azithromycin for Helicobacter pylori eradication: Low cost, high compliance, but low efficacy

Background: The Brazilian consensus recommends a short-term treatment course with clarithromycin, amoxicillin and proton-pump inhibitor for the eradication of Helicobacter pylori ( H. pylori). This treatment course has good efficacy, but cannot be afforded by a large part of the population. Azithromycin, amoxicillin and omeprazole are subsidized, for several aims, by the Brazilian federal government. Therefore, a short-term treatment course that uses these drugs is a low-cost one, but its efficacy regarding the bacterium eradication is yet to be demonstrated. The study's purpose was to verify the efficacy of H. pylori eradication in infected patients who presented peptic ulcer disease, using the association of azithromycin, amoxicillin and omeprazole. Methods: Sixty patients with peptic ulcer diagnosed by upper digestive endoscopy and H. pylori infection documented by rapid urease test, histological analysis and urea breath test were treated for six days with a combination of azithromycin 500 mg and omeprazole 20 mg, in a single daily dose, associated with amoxicillin 500 mg 3 times a day. The eradication control was carried out 12 weeks after the treatment by means of the same diagnostic tests. The eradication rates were calculated with 95% confidence interval. Results: The eradication rate was 38% per intention to treat and 41% per protocol. Few adverse effects were observed and treatment compliance was high. Conclusion: Despite its low cost and high compliance, the low eradication rate does not allow the recommendation of the triple therapy with azithromycin as an adequate treatment for H. pylori infection.

Efficacy of a 7-day course of furazolidone, levofloxacin, and lansoprazole after failed Helicobacter pylori eradication

Background: Increasing resistance to clarithromycin and nitroimidazole is the main cause of failure in the Helicobacter pylori eradication. The ideal retreatment regimen remains unclear, especially in developing countries, where the infection presents high prevalence and resistance to antibiotics. The study aimed at determining the efficacy, compliance and adverse effects of a regimen that included furazolidone, levofloxacin and lansoprazole in patients with persistent Helicobacter pylori infection, who had failed to respond to at least one prior eradication treatment regimen. Methods: This study included 48 patients with peptic ulcer disease. Helicobacter pylori infection was confirmed by a rapid urease test and histological examination of samples obtained from the antrum and corpus during endoscopy. The eradication therapy consisted of a 7-day twice daily oral administration of lansoprazole 30 mg, furazolidone 200 mg and levofloxacin 250 mg. Therapeutic success was confirmed by a negative rapid urease test, histological examination and 14C- urea breath test, performed 12 weeks after treatment completion. The Chi-square method was used for comparisons among eradication rates, previous treatments and previous furazolidone use. Results: Only one of the 48 patients failed to take all medications, which was due to adverse effects (vomiting). Per-protocol and intention-to-treat eradication rates were 89% (95% CI-89%-99%) and 88% (88-92%), respectively. Mild and moderate adverse effects were reported by 41 patients (85%). For patients with one previous treatment failure, the eradication rate was 100%. Compared to furazolidone-nave patients, eradication rates were lower in those who had failed prior furazolidone-containing regimen(s) (74% vs. 100%, p = 0.002). Conclusion: An empiric salvage-regimen including levofloxacin, furazolidone and lansoprazole is very effective in the eradication of Helicobacter pylori, particularly in patients that have failed one prior eradication therapy.

High gravity batch and continuous processes for beer production: Evaluation of fermentation performance and beer quality

This study deals with two innovative brewing processes, high gravity batch and complete continuous beer fermentation systems. The results show a significant influence of the variables such as concentration and temperature on the yield factor of the substrate into ethanol and consequently on the productivity of the high gravity batch process. The technological feasibility of continuous production of beer based on yeast immobilization on cheap alternative carriers was also demonstrated. The influence of process parameters on fermentation performance and quality of the obtained beers was studied by sensorial analysis. No significant difference in the degree of acceptance between the obtained products and some traditional market brands was found. (c) 2008 Institute of Chemistry, Slovak Academy of Sciences.

Management Innovation at the Brazilian Superior Tribunal of Justice

We describe administrative reform involving management innovation undertaken at the Superior Tribunal of Justice, Brazil`s highest appellate court for infra-constitutional cases. The innovation is the introduction of a new management model based on strategic planning and a process management approach to work processes. Introduction of the new model has been supported by the use of information technology and project management techniques. Qualitative methods were used for data collection and analysis. Findings reveal that the innovation is contributing to the development of a systemic overview of key processes, reducing the fragmenting effects of the division of work activities within the Tribunal. At least three new organizational routines or capabilities have been developed as a result of the innovation studied: Electronic Court Management, Project Management, and Process Management. The paper contributes to knowledge about court management, a field that has received little research attention in the public administration literature.

Helicobacter pylori Reinfection in Brazilian Patients with Peptic Ulcer Disease: A 5-Year Follow-Up

Background: The Helicobacter pylori reinfection seems to be higher in developing countries, than in developed ones. The aim of the study was to determine the annual recurrence rate of H. pylori, in Brazilian patients with peptic ulcer disease, in a 5-year follow-up. Methods: Patients, with peptic ulcer disease diagnosed by upper digestive endoscopy (UDE) and H. pylori infection verified by histological analysis, rapid urease test, polymerase chain reaction, and urea breath test (UBT), were treated for bacterial eradication. The cure of the infection was verified using the same tests, 3 months after. Clinical evaluation and UBT were performed after sixth and ninth month. After 1 year of follow-up, UBT and UDE were repeated. Up to the fifth year, patients were assessed twice a year and an UBT was performed annually. The patients included and all the reinfected were tested for 15 different genes of the H. pylori. Results: One hundred and forty-seven patients were followed: 19 for 1 year, eight for 2 years, four for 3 years, five for 4 years, and 98 for 5 years, totaling 557 patients/years. Recurrence did not occur in the first year. In the second year, two patients were reinfected; in the third, four patients; in the fourth, three patients; and in the fifth, one patient. The total of reinfected patients was 10. The annual reinfection rate was 1.8%. Conclusion: Brazil presents a low prevalence of H. pylori reinfection, similar to the developed countries.

Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results

Aims Neurally meditated reflex or neurocardiogenic or vasovagal syncope (NMS) is usually mediated by a massive vagal reflex. This study reports the long-term outcome of NMS therapy based on endocardial radiofrequency (RF) catheter ablation of the cardiac vagal nervous system aiming permanent attenuation or elimination of the cardioinhibitory reflex (cardioneuroablation). Methods and results A total of 43 patients (18F/25M, 32.9+/-15 years) without apparent cardiopathy (left ventricular ejection fraction=68.6+/-5%) were included. All had recurrent NMS (4.7+/-2 syncope/patient) with important cardioinhibition (pauses=13.5+/-13 s) at head-up tilt test (HUT), normal electrocardiogram (ECG), and normal atropine test (AT). The patients underwent atrial endocardial RF ablation using spectral mapping to track the neurocardiac interface (AF Nest Mapping). The follow-up (FU) consisted of clinical evaluation, ECG (1 month/every 6 months/or symptoms), Holter (every 6 months/or symptoms), HUT (>= 4 months/or symptoms), and AT (end of ablation and >= 6 months). A total of 44 ablations (48+/-9 points/patient) were performed. Merely three cases of spontaneous syncope occurred in 45.1+/-22 months (two vasodepressor, one undefined). Only four partial cardioinhibitory responses occurred in post-ablation HUT without pauses or asystole (sinus bradycardia). Long-term AT (21.7+/-11 months post) was negative in 33 (76.7%, P<0.01), partially positive in 7(16.3%), and normal in three patients only (6.9%) reflecting long-term vagal denervation (AT-Delta% HR pre 79.4% x 23.2% post). The post-ablation stress test and Holter showed no abnormalities. No major complications occurred. Conclusion Endocardial RF catheter ablation of severe neurally meditated reflex syncope prevented pacemaker implantation and showed excellent long-term results in well selected patients. Despite no action in vasodepression it seems to cause enough long-term vagal reflex attenuation, eliminating the cardioinhibition, and keeping most patients asymptomatic. Indication was based on clinical symptoms, reproduction of severe cardioinhibitory syncope, and normal atropine response.

Effect of surfactants on the functional properties of gelatin-based edible films

The aim of this research was to evaluate the plasticizing effect of natural surfactants lecithin or yucca extract from Yucca schidigera on gelatin-based films Films containing yucca extract showed higher tensile strength values (similar to 90-40 MPa) and moisture contents (similar to 15%) and less elongation (similar to 5%) and water vapor permeability values (similar to 0 22-009 g mm m(-2) h(-1) kPa(-1)) compared to films containing lecithin Soluble films (similar to 20-50%) were obtained when yucca extract was used while lecithin produced low soluble films (<10%) The opacity of the films (similar to 14 5-16 2%) was similar for both surfactants and the film surface morphologies were continuous and homogeneous X-ray diffraction indicated that the addition of surfactants produced amorphous films compared to gelatin-based films and FT-Infrared spectroscopy showed no evidence of association between the surfactants and the gelatin The plasticizing effect was not obtained after surfactants addition and casting technique (C) 2010 Elsevier Ltd All rights reserved

Permanent Genetic Resources added to Molecular Ecology Resources Database 1 May 2009-31 July 2009

This article documents the addition of 512 microsatellite marker loci and nine pairs of Single Nucleotide Polymorphism (SNP) sequencing primers to the Molecular Ecology Resources Database. Loci were developed for the following species: Alcippe morrisonia morrisonia, Bashania fangiana, Bashania fargesii, Chaetodon vagabundus, Colletes floralis, Coluber constrictor flaviventris, Coptotermes gestroi, Crotophaga major, Cyprinella lutrensis, Danaus plexippus, Fagus grandifolia, Falco tinnunculus, Fletcherimyia fletcheri, Hydrilla verticillata, Laterallus jamaicensis coturniculus, Leavenworthia alabamica, Marmosops incanus, Miichthys miiuy, Nasua nasua, Noturus exilis, Odontesthes bonariensis, Quadrula fragosa, Pinctada maxima, Pseudaletia separata, Pseudoperonospora cubensis, Podocarpus elatus, Portunus trituberculatus, Rhagoletis cerasi, Rhinella schneideri, Sarracenia alata, Skeletonema marinoi, Sminthurus viridis, Syngnathus abaster, Uroteuthis (Photololigo) chinensis, Verticillium dahliae, Wasmannia auropunctata, and Zygochlamys patagonica. These loci were cross-tested on the following species: Chaetodon baronessa, Falco columbarius, Falco eleonorae, Falco naumanni, Falco peregrinus, Falco subbuteo, Didelphis aurita, Gracilinanus microtarsus, Marmosops paulensis, Monodelphis Americana, Odontesthes hatcheri, Podocarpus grayi, Podocarpus lawrencei, Podocarpus smithii, Portunus pelagicus, Syngnathus acus, Syngnathus typhle,Uroteuthis (Photololigo) edulis, Uroteuthis (Photololigo) duvauceli and Verticillium albo-atrum. This article also documents the addition of nine sequencing primer pairs and sixteen allele specific primers or probes for Oncorhynchus mykiss and Oncorhynchus tshawytscha; these primers and assays were cross-tested in both species.

Sustained activation of p53 in confluent nucleotide excision repair-deficient cells resistant to ultraviolet-induced apoptosis

p53 activation is one of the main signals after DNA damage, controlling cell cycle arrest, DNA repair and apoptosis. We have previously shown that confluent nucleotide excision repair (NER)-deficient cells are more resistant to apoptosis induced by ultraviolet irradiation (UV). Here, we further investigated the effect of cell confluence on UV-induced apoptosis in normal and NER-deficient (XP-A and XP-C) cells, as well as the effects of treatments with the ATWATR inhibitor caffeine, and the patterns of p53 activation. Strong p53 activation was observed in either proliferating or confluent cells. Caffeine increased apoptosis levels and inhibited p53 activation in proliferating cells, suggesting a protective role for p53. However, in confluent NER-deficient cells no effect of caffeine was observed. Transcription recovery measurements showed decreased recovery in proliferating XPA-deficient cells, but no recovery was observed in confluent cells. The levels of the cyclin/Cdk inhibitor, p21(Waf1/Cip1), correlated well with p53 activation in proliferating cells. Surprisingly, confluent cells also showed similar activation of p21(Waf1/Cip1). These results indicate that reduced apoptosis in confluent cells is associated with the deficiency in DNA damage removal, since this effect is not clearly observed in NER-proficient cells. Moreover, the strong activation of p53 in confluent cells, which barely respond to apoptosis, suggests that this protein, under these conditions, is not linked to UV-induced cell death signaling. (c) 2008 Elsevier B.V. All rights reserved.

A non-autonomous strongly damped wave equation: Existence and continuity of the pullback attractor

In this paper we consider the strongly damped wave equation with time-dependent terms u(tt) - Delta u - gamma(t)Delta u(t) + beta(epsilon)(t)u(t) = f(u), in a bounded domain Omega subset of R(n), under some restrictions on beta(epsilon)(t), gamma(t) and growth restrictions on the nonlinear term f. The function beta(epsilon)(t) depends on a parameter epsilon, beta(epsilon)(t) -> 0. We will prove, under suitable assumptions, local and global well-posedness (using the uniform sectorial operators theory), the existence and regularity of pullback attractors {A(epsilon)(t) : t is an element of R}, uniform bounds for these pullback attractors, characterization of these pullback attractors and their upper and lower semicontinuity at epsilon = 0. (C) 2010 Elsevier Ltd. All rights reserved.

A GRADIENT-LIKE NONAUTONOMOUS EVOLUTION PROCESS

In this paper we consider a dissipative damped wave equation with nonautonomous damping of the form u(tt) + beta(t)u(t) - Delta u + f(u) (1) in a bounded smooth domain Omega subset of R(n) with Dirichlet boundary conditions, where f is a dissipative smooth nonlinearity and the damping beta : R -> (0, infinity) is a suitable function. We prove, if (1) has finitely many equilibria, that all global bounded solutions of (1) are backwards and forwards asymptotic to equilibria. Thus, we give a class of examples of nonautonomous evolution processes for which the structure of the pullback attractors is well understood. That complements the results of [Carvalho & Langa, 2009] on characterization of attractors, where it was shown that a small nonautonomous perturbation of an autonomous gradient-like evolution process is also gradient-like. Note that the evolution process associated to (1) is not a small nonautonomous perturbation of any autonomous gradient-like evolution processes. Moreover, we are also able to prove that the pullback attractor for (1) is also a forwards attractor and that the rate of attraction is exponential.

Existence of pullback attractors for pullback asymptotically compact processes

This paper is concerned with the existence of pullback attractors for evolution processes. Our aim is to provide results that extend the following results for autonomous evolution processes (semigroups) (i) An autonomous evolution process which is bounded, dissipative and asymptotically compact has a global attractor. (ii) An autonomous evolution process which is bounded, point dissipative and asymptotically compact has a global attractor. The extension of such results requires the introduction of new concepts and brings up some important differences between the asymptotic properties of autonomous and non-autonomous evolution processes. An application to damped wave problem with non-autonomous damping is considered. (C) 2009 Elsevier Ltd. All rights reserved.