Reflexões psicanalíticas winnicottianas sobre o sentido do silêncio no setting

We tried to analyze in this paper the meaning of silence into the analytical setting, based in Winnicott’s proposal of psychoanalysis and from clinical experience fragments of one the authors. Therefore, we surveyed the meaning of silence in the setting for some psychoanalysts and, afterwards, we made reference mainly to the concepts related to Winnicott’s Theory of the Emotional Maturity, such as holding, handling, the presentation of objects, and those concerning hesitation and transitionality. We further availed ourselves of the concepts of transference and count transference to ponder on the therapeutic dyad into the analytical setting. Our final considerations point to the need to consider silence as an important communication in certain circumstances of the therapeutic work, as well as suggesting that the setting, in this case study, requested hopeful non-invasive approach of the therapist, to allow the appearance of transitional space through which the emotional maturity can be resumed in this patient.

Utilization of peritoneal dialysis in the acute setting

Peritoneal dialysis (PD), although classically described and utilized in the treatment of patients with end-stage renal disease, can also be utilized in the acute setting in different clinical situations. Recent studies showed that, in patients with acute renal failure, it is possible to obtain reasonable dialysis doses with adequate metabolic and etectrolytic control and tow incidence of complications by utilizing continuous PD through a cycler at high volume. In patients with congestive heart failure without end-stage renal disease, PD is capable of promoting clinical improvement with slow removal of liquids, becoming an attractive alternative for situations of rapidly or slowly worsening cardiac function. In patients submitted to chronic hemodialysis but who have vascular access difficulties, PD can also be utilized as a bridge, thereby avoiding the use of central venous catheters, which can be associated with infectious complications such as bacterial endocarditis. New studies must be realized showing other indications for PD.

Tectonic setting and U/Pb zircon dating of the plutonic Socorro Complex in the Transpressive Rio Paraíba do Sul Shear Belt, SE Brazil

The Precambrian Rio Paraíba do Sul Shear Belt comprises a 200-km-wide anastomosing network of NE-SW trending ductile shear zones extending over 1000 km of the southeastern coast of Brazil. Granulitic, gneissic-migmatitic, and granitoid terrains as well as low- to medium-grade metavolcanosedimentary sequences are included within it. These rocks were affected by strong contractional, tangential tectonics, due to west-northwestward oblique convergence of continental blocks. Subsequent transpressional tectonics accomodated large dextral, orogen-parallel movements and shortening. The plutonic Socorro Complex is one of many deformed granites with a foliation subparallel to that of the shear belt and exposes crosscutting relationships between its tectonic, magmatic, and metamorphic structures. These relationships point to a continuous magmatic evolution related to regional thrusts and strike slip, ductile shear zones. The tectonic and magmatic structural features of the Serra do Lopo Granite provide a model of emplacement by sheeting along shear zones during coeval strike-slip and cross shortening of country rocks. Geochronological data indicate that the main igneous activity of Socorro Complex spanned at least 55 million years, from the late stage of the northwestward ductile thrusting (650 Ma), through right-lateral strike slip (595 Ma) deformation. The country rocks yield discordant age data, which reflect a strong imprint of the Transamazonian tectono-metamorphic event (1.9 to 2.0 Ma). We propose a model for the origin of calcalkaline granites of the Ribeira Belt by partial melting of the lower crust with small contributions of the lithospheric mantle during transpressional thickening of plate margins, which were bounded by deep shear zones. The transpressional regime also seems to have focused granite migration from deeper into higher crustal levels along these shear zones.

Library exceptions in the copyright laws of Ibero-American countries

The development of the digital setting has made it absolutely necessary to revise copyright legislation as a whole, including the exceptions that benefit libraries and similar institutions. Unfortunately, adaptation to the new technological reality is not taking place satisfactorily in most countries - the predominating trend is a refortification of copyright as opposed to user interests, and the maintenance of a certain pre-digital philosophy. In the case of Ibero-America the problem is twofold: aside from obsolescence or a lack of adaptation to the new technological setting, there are countries that have not yet included library-related exceptions in the national laws. Moreover, these happen to be developing countries, whose needs and interests do not coincide with those of the richer nations who paved the path to be followed by international treaties and copy- or copyright agreements. This study looks into the situation of exceptions to copyright to benefit libraries in the countries constituting Ibero-America, with a comparative analysis of the most significant characteristics of their national laws. It is concluded that it is crucial for these countries to take advantage of the options offered through the WIPO Copyright Treaty of 1996 and the results of the WIPO Development Agenda to update their legislation, in order that copyright will be respected, while at the same time making it easier for libraries to continue carrying out their social function in an adequate manner, always with the understanding of the developmental context of these countries.

Identification of dementia cases in the community: A Brazilian experience

OBJECTIVES: To describe the application in Brazil of a simple, low-cost procedure, developed in India by the 10/66 Dementia Research Group, for the identification of dementia cases in the community.DESIGN: Community-based dementia case-finding method.SETTING: Piraju, São Paulo, Brazil.PARTICIPANTS: Twenty-five community health workers were trained to identify dementia cases in 2,222 people aged 65 and older in Piraju, a Brazilian town with 27,871 inhabitants.MEAUREMENTS: After the training, the health workers prepared a list of possible cases that afterward an experienced psychiatrist clinically evaluated, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria and the Clinical Dementia Rating.RESULTS: of the 72 cases that were clinically assessed, 45 met the DSM-IV diagnostic criteria for dementia. Therefore, the positive predictive value of this case finding method was 62.5%; the estimated frequency of dementia was 2%. Most of the confirmed cases met clinical criteria for Alzheimer's disease and vascular dementia.CONCLUSION: This simple method was appropriate to identify cases of dementia in the general population and can possibly be extended to other developing countries with limited resources to be applied in health programs.

Autopsy: quality assurance in the ICU

Objective: To examine the correlation between the clinical diagnosis and autopsy findings in adult patients who died in an intensive care unit (ICU). To determine the rate of agreement of the basic and terminal causes of death and the types of errors in order to improve quality control of future care,Design, Retrospective study.Setting: Adult ICU in a university hospital.Patients: 30 adult patients who died in the ICU. with the exclusion of medicolegal cases.Methods and main results: Anatomo-clinical meetings were held to analyze the pre- and postmortem correlations in 30 consecutive autopsies at the ICU of the University Hospital, School of Medicine of Botucatu/ UNESP, from January 1994 to January 1997. The rate of correct clinical diagnoses of the basic cause was 66.7 %; in 23.3 % of cases, if the correct diagnosis was made, management would have been different, as would have been the evolution of the patient's course (Class I error): in 10 % of the cases the error would not have led to a change in management (Class II error). The rate of correct clinical diagnoses of terminal cause was 80 %.Conclusions: the rate of recognition of the basic cause was 66.7 %, which is consistent with the literature, but the Class I error rate was higher than that reported in the literature.

The Influence of Calcium Chloride on the Setting Time, Solubility, Disintegration, and pH of Mineral Trioxide Aggregate and White Portland Cement with a Radiopacifier

This study evaluated the influence of addition of 10% calcium chloride (CaCl(2)) on the setting time, solubility, disintegration, and pH of white MTA (WMTA) and white Portland cement (WPC). A test of the setting time was performed following the #57 ADA specifications and a test of the final setting time according to the ASTM. For the solubility tests disintegration and pH, Teflon rings were filled with the cements and weighed after setting. After 24 h in a desiccator, they were once again weighed. Thereafter, they were immersed in MiliQ water for 24 and 72 h and 7, 14, and 28 days, with maintenance in the desiccator and weighing between periods. The pH of water in which the rings were immersed was measured immediately after contact with them and in the other periods. The addition of CaCl(2) provided a significant reduction (50%) in the initial setting time of cements. The final setting time of WMTA was reduced in 35.5% and the final setting time of WPC in 68.5%. The WMTA with CaCl(2) absorbed water and gained weight with time, except for in the 24-h period. The addition of CaCl(2) to the WPC reduced its solubility. The addition of CaCl(2) increased the pH of WMTA in the immediate period and at 24 and 72 h and for WPC in the immediate period and at 24 h. The addition of CaCl(2) to WMTA and WPC reduced the setting times and solubility of both and increased the pH of cements in the initial periods. (J Endod 2009;35:550-554)

Orchidopexy restores morphometric-stereologic changes in the caput epididymis and daily sperm production in cryptorchidic mice, although sperm transit time and fertility parameters remain impaired

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influence of sedation on morbidity and mortality in the intensive care unit

CONTEXTO: Embora cerca de 30% a 50% dos pacientes hospitalizados em unidades de terapia intensiva (UTI) recebam algum tipo de sedativo, existe escassez de informações sobre efeitos adversos desta prática, especialmente no Brasil. Estes efeitos podem ser significantes e o uso de sedativos é associado a elevação de infecção e mortalidade, mesmo sendo difícil avaliar o impacto clínico deste procedimento. OBJETIVO: Avaliar o impacto da sedação sobre incidência de complicações e mortalidade em doentes graves durante internação em unidade de terapia intensiva. TIPO DE ESTUDO: Estudo prospectivo. LOCAL: Unidade de Terapia Intensiva Cirúrgica da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina. PARTICIPANTES: Após excluídos pacientes que permaneceram menos de 24 horas ou sem exames indispensáveis para o cálculo do índice de gravidade (APACHE II), restaram 307 pacientes. Estes foram divididos em dois grupos: Grupo Sedado e Grupo Não Sedado. Constatada heterogeneidade com relação ao APACHE II, foram pareados 97 sedados e 97 não sedados com idênticos índices de gravidade. VARIÁVEIS ESTUDADAS: Impacto da sedação e das técnicas sobre a mortalidade, tempo de internação, além da incidência de escara de decúbito ou pressão, trombose venosa profunda e infecção. RESULTADOS: Não houve diferença na incidência de trombose venosa profunda, entre os grupos Sedado e Não Sedado, enquanto que escara de decúbito foi significativamente maior nos sedados (p = 0,03). Infecção foi detectada em 45,4% dos pacientes com sedação e em 21,6% dos pacientes sem sedação (p = 0,006). A mortalidade para os pacientes que não receberam qualquer tipo de sedativo foi de 20,6% e, para aqueles que foram sedados durante a internação, foi de 52,6% (p < 0,0001). CONCLUSÕES: Conclui-se que a sedação está associada a maior duração da internação, morbidade e mortalidade significativas. Apesar da intensidade das associações encontradas, não é possível estabelecer relação causal entre sedação e mortalidade.

Increase on incineration capacity and NOx control for air enrichment in the experimental simulation of aqueous residue incineration

An experimental investigation of air enrichment in a combustion chamber designed to incinerate aqueous residues is presented. Diesel fuel and liquefied petroleum gas (LPG) were used independently as fuels. An increase of 85% in the incineration capacity was obtained with nearly 50% O-2 in the oxidant gas, in comparison to incineration with air only. The incineration capacity continues increasing for enrichment levels above 50% O-2 , although at a lower pace. For complete oxy-flame combustion (100% O-2 ), the increase of the incineration capacity was about 110% relative to the starting conditions and about 13.5% relative to the condition with 50% O-2 . The CO concentration measured near the flame front decreases drastically with the increase of O-2 content in the oxidant gas. At the chamber exit, the CO concentration was always near zero, indicating that the chamber residence time was sufficient to complete fuel oxidation in any test setting. For diesel fuel, the NOx was entirely formed in the first region of the combustion chamber. For diesel fuel, there was some increase in the NOx concentration up to 35% of O-2 ; this increase became very sharp after that. From 60 ppm, at operation with air only, the NOx concentration raises to 200 ppm at 35% O-2 , and then to 2900 ppm at 74% O-2 . The latter corresponds to six times more NOx in terms of the ratio of mass of NO to mass of residue, compared to the situation of combustion with air only. For LPG, the NOx concentrations reached 4200 ppm at 80% O-2 , corresponding to nine times more, also in terms of the ratio of mass of NO to mass of residue, in comparison with combustion with air only. Results of different techniques used to control the NOx emission during air enrichment are discussed: (a) variation of the recirculated zone intensity, (b) increase of the spray Sauter mean diameter, (c) fuel staging, (d) oxidizer staging, and (e) ammonia injection. The present paper shows that NOx emission may be controlled without damage of the increase of incineration capacity by the enrichment and with low emission of partial oxidation pollutants such as CO.

SPATIAL-ORGANIZATION OF FORAGING ACTIVITY AND COLONIZATION BY COLONY EMIGRATION IN THE PHARAOH ANT, MONOMORIUM-PHARAONIS

Using food bait stations and colony trap nests, the spatial relation between the foraging activity of established colonies of the polygynous and unicolonial exotic pharaoh's ant, Monomorium pharaonis, and colonization by colony fragments was studied over an 8 month period in a large institutional setting in Brazil. Both foraging activity and colonizations demonstrated significant spatial clumping. However, colonizations were significantly negatively clumped spatially with respect to foraging activity. This suggests that the colonization strategy of this species under the studied conditions was that of complete habitat domination.

Geological evolution of the basement rocks in the east-central part of the Rondonia Tin Province, SW Amazonian craton, Brazil: U-Pb and Sm-Nd isotopic constraints

On the basis of geologic, petrologic, and U-Pb geochronologic data the basement rocks in the east-central part of the Rondonia Tin Province (RTP, southwestern Amazonian craton) are grouped into five lithologic associations: (1) tonalitic gneiss (1.75 Ga); (2) enderbitic granulite (1.73 Ga); (3) paragneiss; (4) granitic and charnockitic augen gneisses (1.57-1.53 Ga); and (5) fine-grained granitic gneiss and charnockitic granulite (1.43-1.42 Ga). The first three are related to development of the Paleoproterozoic Rio Negro-Juruena Province and represent the oldest crust in the region. The tonalitic gneisses and enderbitic granulites show calc-alkaline affinities and Nd isotopic compositions (initial epsilon(Nd) = +0-1 to -1.5; T-DM of 2.2-2.1 Ga) that suggest a continental arc margin setting for the original magmas. The paragneisses yield T-DM values of 2.2-2.1 Ga suggesting that source material was primarily derived from the Ventuari-Tapajos and Rio Negro-Juruena crusts, but detrital zircon ages and an intrusive granitoid bracket deposition between 1.67 and 1.57 Ga. The granitic and charnockitic augen gneisses show predominantly A-type and within-plate granite affinities, but also some volcanic arc granite characteristics. The initial epsilon(Nd) values (+0.6 to +2.0) indicate mixing of magmas derived from depleted mantle and older crustal sources. These rocks are correlated to the 1.60-1.53 Ga Serra da Providencia intrusive suite that reflects inboard magmatism coeval with the Cachoeirinha orogen located to the southeast. The fine-grained granitic gneiss and charnockitic granulites represent the first record of widespread magmatism at 1.43-1.42 Ga in northern Rondonia. Their geochemical signatures and the slightly positive initial epsilon(Nd) values (+0.7 to +1.2) are very similar to those of the most evolved granites of the calc-alkaline Santa Helena batholith farther southeast. U-Pb monazite and Sm-Nd whole-rock-garnet ages demonstrate that a high-grade tectonometa-morphic episode occurred in this region at 1.33-1.30 Ga. This episode attained upper-amphibolite conditions and is interpreted as the peak of the Rondonian-San Ignacio orogeny. The U-Pb and Sm-Nd data presented here and data published on rapakivi granites elsewhere indicate that the east-central part of the RTP is a poly-orogenic region characterized by successive episodes of magmatism, metamorphism, and deformation between 1.75 and 0.97 Ga. (C) 2002 Elsevier B.V. B.V. All rights reserved.

Evaluation of the thermal shrinkage of titanium and the setting and thermal expansion of phosphate-boded investments

Statement of problem. There are few studies on titanium casting shrinkage, and phosphate-bonded investments for titanium casting have not produced appropriate marginal fit.Purpose. The purpose of this study was to determine the thermal shrinkage of titanium and the setting and thermal expansion of 3 phosphate-bonded investments.Material and methods. The thermal shrinkage between the melting temperature and room temperature was calculated using a titanium thermal expansion coefficient. The thermal and setting expansion were measured for 3 phosphate bonded investments: Rematitan Plus (RP) specific for titanium, Rema Exakt (RE), and Castorit Super C (CA), using different special liquid concentrations (100%, 75%, and 50%). Setting expansion was measured for cylindrical specimens 50 mm long x 8 mm in diameter with a transducer. The heating and cooling curves were obtained with a dilatometer (DIL 402 PC). The total expansion curve was drawn using software, and temperatures to obtain expansion equivalent to titanium casting shrinkage were determined (n=5). In addition, the total expansion of the control group (RP at 430 degrees C) was measured, as well as the temperatures at which the other groups achieved equivalent total expansion (n=5). Data were analyzed by 1-way ANOVA and the Tukey HSD test (alpha=.05).Results. Titanium casting shrinkage was estimated as 1.55%. RP did not achieve this expansion. RE achieved expansion of 1.55% only with a special liquid concentration of 100% at 594 degrees C. CA with all special liquid concentrations attained this expansion (351 degrees C to 572 degrees C). Total expansion of the control group was 0.86%, and the other groups reached that expansion within the range of 70 degrees C to 360 degrees C.Conclusions. Only RE and CA demonstrated sufficient expansion to compensate for titanium casting shrinkage. All groups reached total expansion equivalent to that of the control group at significantly lower temperatures.

HERBIVORY AND ASSEMBLAGE STRUCTURE OF MYRMECOPHYTOUS UNDERSTORY PLANTS AND THEIR ASSOCIATED ANTS IN THE CENTRAL AMAZON

The species combinations of myrmecophytic plants were compared in three different, neighboring local central Amazon forest sites. The proportional contribution of myrmecophytes in each setting varied significantly, with Maieta guainensis being the most abundant in each locality. This pattern resulted in low site similarity values. Other recorded species were Hirtella physophora, Tachigalia myrmecophila, Duroia sp., Tococa sp., and Cordia nodosa. Little variability was found with respect to associated ants that inhabited the myrmecophytes, and mutual entropies indicated a high degree of mutualistic interactions. However, for the majority of myrmecophytes, no differences in herbivore damage levels could be attributed to the presence of ants, with only M. guianensis and T. myrmecophila demonstrating significantly lower damages when inhabited by ants. Their respective ant associates, Pheidole minitula and Pseudomyrmex concolor, were thus the only plant-ants with a demonstrable ability to reduce the levels of herbivory in their host plant.

Predictors of incorrectness in antimicrobial prescription in the Bauru State Hospital (Bauru city, São Paulo State, Brazil)

The inappropriate use of antimicrobials in hospitals presents a negative impact on patient outcome and is associated with the emergence and spread of multidrug-resistant microorganisms. Antimicrobial stewardship programs (ASPs) have been instituted in order to improve the quality of prescriptions in hospitals. In this setting, the identification of patterns of inappropriate antimicrobial prescription is a valuable tool that allows ASPs to identify priorities for directing educative/restrictive policies. With this purpose, a study was conducted in the Bauru State Hospital, a teaching hospital with 285 beds affiliated to the Botucatu Medical School, São Paulo State University. The hospital maintains an active ASP since it was opened, in 2002. We selected 25% of the requests for parenteral antimicrobials (RPAs) from 2005 for analysis. Prescriptions for prophylactic purposes were excluded. All other RPAs were classified according to a modified Kunin and Jones categories. Univariate and multivariable analyses were performed to identify predictors of general inappropriateness and of specific prescription errors. Prescriptions classified as "appropriate'' or "probably appropriate" were selected as controls in all stages of the study. Among 963 RPAs included in our study, 34.6% were inappropriate. General predictors of inappropriateness were: prescription on weekends/holidays (OR = 1.67, 95% CI = 1.20-2.28, p = 0.002), patient from intensive care unit (OR = 1.57, 95% CI = 1.11-2.23, p = 0.01), peritoneal (OR = 2.15, 95% CI = 1.27-3.65, p = 0.004) or urinary tract infection (OR = 1.89, 95% CI = 1.25-2.87, p = 0.002), combined therapy with two or more antimicrobials (OR = 1.72, 95% CI = 1.15-2.57, p = 0.008) and prescriptions including penicillin (OR = 2.12, 95% CI = 1.39-3.25, p = 0.001) or first-generation cephalosporins (OR = 1.74, 95% CI = 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR = 0.34, 95% CI = 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR = 0.04, 95% CI = 0.01-0.26, p = 0.001) and requests for agents with insufficient spectrum (OR = 0.14, 95% CI = 0.03-0.30, p = 0.01). In conclusion, the analysis of factors predictive of inappropriateness in antimicrobial prescription allowed us to identify issues requiring intervention. Also, it provided a positive feedback of the ASP efficacy, demonstrating the importance of previous consultation with an ID specialist to assure the quality of antimicrobial prescriptions.