Chapter II: Diagnostic methods

Non-invasive vascular studies can provide crucial information on the presence, location, and severity of critical limb ischaemia (CLI), as well as the initial assessment or treatment planning. Ankle-brachial index with Doppler ultrasound, despite limitations in diabetic and end-stage renal failure patients, is the first-line evaluation of CLI. In this group of patients, toe-brachial index measurement may better establish the diagnosis. Other non-invasive measurements, such as segmental limb pressure, continuous-wave Doppler analysis and pulse volume recording, are of limited accuracy. Transcutaneous oxygen pressure (TcPO(2)) measurement may be of value when rest pain and ulcerations of the foot are present. Duplex ultrasound is the most important non-invasive tool in CLI patients combining haemodynamic evaluation with imaging modality. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the next imaging studies in the algorithm for CLI. Both CTA and MRA have been proven effective in aiding the decision-making of clinicians and accurate planning of intervention. The data acquired with CTA and MRA can be manipulated in a multiplanar and 3D fashion and can offer exquisite detail. CTA results are generally equivalent to MRA, and both compare favourably with contrast angiography. The individual use of different imaging modalities depends on local availability, experience, and costs. Contrast angiography represents the gold standard, provides detailed information about arterial anatomy, and is recommended when revascularisation is needed.

Railroad reorganization : Hearing before the Special subcommittee on bankruptcy and reorganization of the Committee on the judiciary, House of representatives, seventy-sixth Congress, first session on S. 1869; an act to protect interstate commerce from the dangers of unsound financial structures and to establish improved procedures and standards for financial rehabilitation of railroads engaged in interstate commerce, and for other purposes.

Serial no. 11.

Speech of Mr. Fessenden, of Maine, on the bankrupt bill : delivered in the House of Representatives of the United States, August 11, 1841.

Mode of access: Internet.

Essays on Personal Bankruptcy Law and Small Business Financing

Thesis (Ph.D.)--University of Washington, 2016-06

Chapter 8 HPV vaccines

Vaccines to prevent infection with high-risk human papillomaviruses (HPV) will help protect women against cervical cancer, and some are likely to be available within the next year. One vaccine, a quadrivalent vaccine against HPV types 6, 11, 16 and 18 and known as Garadsil ©(Merck &Co., Inc), was approved by the Federal Drug Administration (FDA) for the prevention of cervical cancer, cervical cancer precursors and vulval and vaginal cancer precursors associated with HPV 16 and 18 in June 2006. In addition, the vaccine has been approved for the prevention of genital warts and low grade cervical lesions e.g. cervical intraepithelial neoplasia1. The main vaccines components are recombinant viral capsid proteins assembled into virus-like particles and alum-based adjuvants. If given before HPV infection, the vaccines, which induce HPV type-specific, virus-neutralizing antibodies, have proven safe and highly effective at preventing HPV infection and its clinical consequences, including high-grade cervical lesions. Their use should not immediately alter existing screening programs for cervical cancer, however. Because they incorporate only the 2 HPV types most commonly associated with cervical cancer (HPV-16 and HPV-18), they can only prevent about 70% of cervical cancers. Vaccines to treat existing HPV infection are under development but are unlikely to become clinically available in the near future.

Synthesis and Properties of a Series of 1,1,n,n-Tetramethyl[n](2,11)teropyrenophanes

The work described in this thesis revolves around the 1,1,n,ntetramethyl[n](2,11)teropyrenophanes, which are a series of [n]cyclophanes with a severely bent, board-shaped polynuclear aromatic hydrocarbons (PAH). The thesis is divided into seven Chapters. The first Chapter conatins an overview of the seminal work on [n]cyclophanes of the first two members of the “capped rylene” series of PAHs: benzene and pyrene. Three different general strategies for the synthesis of [n]cyclophanes are discussed and this leads in to a discussion of some slected syntheses of [n]paracyclopahnes and [n](2,7)pyrenophanes. The chemical, structural, spectroscopic and photophysical properties of these benzene and pyrene-derived cyclophanes are discussed with emphasis on the changes that occur with changes in the structure of the aromatic system. Chapter 1 concludes with a brief introduction to [n]cyclophanes of the fourth member of the capped rylene series of PAHs: teropyrene. The focus of the work described in Chapter 2 is the synthesis of of 1,1,n,ntetramethyl[n](2,11)teropyrenophane (n = 6 and 7) using a double-McMurry strategy. While the synthesis 1,1,7,7-tetramethyl[7](2,11)teropyrenophane was successful, the synthesis of the lower homologue 1,1,6,6-tetramethyl[6](2,11)teropyrenophane was not. The conformational behaviour of [n.2]pyrenophanes was also studied by 1H NMR spectroscopy and this provided a conformation-based rationale for the failure of the synthesis of 1,1,6,6-tetramethyl[6](2,11)teropyrenophane. Chapter 3 contains details of the synthesis of 1,1,n,n-tetramethyl[n](2,11)teropyrenophanes (n = 7-9) using a Wurtz / McMurry strategy, which proved to be more general than the double McMurry strategy. The three teropyrenophanes were obtained in ca. 10 milligram quantities. Trends in the spectroscopic properties that accompany changes in the structure of the teropyrene system are discussed. A violation of Kasha’s rule was observed when the teropyrenophanes were irradiated at 260 nm. The work described in the fourth Chapter concentrates on the development of gram-scale syntheses of 1,1,n,n-tetramethyl[n](2,11)teropyrenophanes (n = 7–10) using the Wurtz / McMurry strategy. Several major modifications to the orginal synthetic pathway had to be made to enable the first several steps to be performed comfortably on tens of grams of material. Solubility problems severely limited the amount of material that could be produced at a late stage of the synthetic pathways leading to the evennumbered members of the series (n = 8, 10). Ultimately, only 1,1,9,9- tetramethyl[9](2,11)teropyrenophane was synthesized on a multi-gram scale. In the final step in the synthesis, a valence isomerization / dehydrogenation (VID) reaction, the teropyrenophane was observed to become unstable under the conditions of its formation at n = 8. The synthesis of 1,1,10,10-tetramethyl[10](2,11)teropyrenophane was achieved for the first time, but only on a few hundred milligram scale. In Chapter 5, the results of an investigation of the electrophilic aromatic bromination of the 1,1,n,n-tetramethyl[n](2,11)teropyrenophanes (n = 7–10) are presented. Being the most abundant cyclophane, most of the work was performed on 1,1,9,9-tetramethyl[9](2,11)teropyrenophane. Reaction of this compound with varying amounts of of bromine revealed that bromination occurs most rapidly at the symmetryrelated 4, 9, 13 and 18 positions (teropyrene numbering) and that the 4,9,13,18- tetrabromide could be formed exclusively. Subsequent bromination occurs selectively on the symmetry-related 6, 7, 15 and 16 positions (teropyrene numbering), but considerably more slowly. Only mixtures of penta-, hexa-, hepta and octabromides could be formed. Bromination reactions of the higher and lower homologues (n = 7, 8 and 10) revealed that the reactivity of the teropyrene system increased with the degree of bend. Crystal structures of some tetra-, hexa-, hepta- and octa-brominated products were obtained. The goal of the work described in Chapter 6 is to use 1,1,9,9- tetramethyl[9](2,11)teropyrenophane as a starting material for the synthesis of warped nanographenophanes. A bromination, Suzuki-Miyaura, cyclodehydrogenation sequence was unsuccessful, as was a C–H arylation / cyclodehydrogenation approach. Itami’s recently-developed K-region-selective annulative -extension (APEX) reaction proved to be successful, affording a giant [n]cyclophane with a C84 PAH. Attempted bay-region Diels-Alder reactions and some cursory host-guest chemistry of teropyrenophanes are also discussed. In Chapter 7 a synthetic approach toward a planar model compound, 2,11-di-tbutylteropyrene, is described. The synthesis could not be completed owing to solubility problems at the end of the synthetic pathway.

The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Riscos de quebra de continuidade e o papel do auditor

Mestrado em Auditoria

Quantum Dots As Biophotonics Tools.

This chapter provides a short review of quantum dots (QDs) physics, applications, and perspectives. The main advantage of QDs over bulk semiconductors is the fact that the size became a control parameter to tailor the optical properties of new materials. Size changes the confinement energy which alters the optical properties of the material, such as absorption, refractive index, and emission bands. Therefore, by using QDs one can make several kinds of optical devices. One of these devices transforms electrons into photons to apply them as active optical components in illumination and displays. Other devices enable the transformation of photons into electrons to produce QDs solar cells or photodetectors. At the biomedical interface, the application of QDs, which is the most important aspect in this book, is based on fluorescence, which essentially transforms photons into photons of different wavelengths. This chapter introduces important parameters for QDs' biophotonic applications such as photostability, excitation and emission profiles, and quantum efficiency. We also present the perspectives for the use of QDs in fluorescence lifetime imaging (FLIM) and Förster resonance energy transfer (FRET), so useful in modern microscopy, and how to take advantage of the usually unwanted blinking effect to perform super-resolution microscopy.

Measuring The Hydrodynamic Radius Of Quantum Dots By Fluorescence Correlation Spectroscopy.

Fluorescence Correlation Spectroscopy (FCS) is an optical technique that allows the measurement of the diffusion coefficient of molecules in a diluted sample. From the diffusion coefficient it is possible to calculate the hydrodynamic radius of the molecules. For colloidal quantum dots (QDs) the hydrodynamic radius is valuable information to study interactions with other molecules or other QDs. In this chapter we describe the main aspects of the technique and how to use it to calculate the hydrodynamic radius of quantum dots (QDs).

"Crescimento humano, composição corporal e desenvolvimento das caracteristicas sexuais secundarias de adolescentes de 11 a 14 anos"

Universidade Estadual de Campinas . Faculdade de Educação Física

Metabólitos secundários das esponjas Aplysina fistularis e Dysidea sp. e atividade antituberculose da 11-cetofistularina-3

The present investigation reports the isolation of aeroplysinin-2, 2-(3,5-dibromo-4-methoxyphenyl)-N,N,N-trimethyletanamonium, 7,9-dibromo-10-hydroxy-8-methoxy-1-oxa-2-azaspiro[4.5]deca-2,6,8-trien-3-carboxylic acid and its methyl ester, 11-oxoaerothionin, aerothionin, 11-keto-12-hydroxyaerothionin, 11-ketofistularin-3 and fistularin-3 from Aplysina fistularis, as well as of furodysinin lactone and 9α,11α-epoxicholest-7-en-3β,5α,6α,10-tetrol-6-acetate from Dysidea sp. Although the extracts of both sponges displayed antituberculosis activity, only 11-ketofistularin-3 isolated from A. fistularis displayed antimycobacterial activity against Mycobacterium tuberculosis H34Rv, with MIC at 16 μg/mL and SI of 40, a result that reinforce that fistularin-3 derivatives are interesting leads for the development of antituberculosis drugs.

Health Related Quality of Life Assessment questionnaire for children aged 5 to 11 years with HIV/AIDS: cross-cultural adaptation for the Portuguese language

The objective of this study is to describe preliminary results from the cross-cultural adaptation of the Quality of Life Assessment Questionnaire, used to measure health related quality of life (HRQL) in Brazilian children aged between 5 and 11 with HIV/AIDS. The cross-cultural model evaluated the Concept, Item, Semantic and Measurement Equivalences (internal consistency and intra-observer reliability). Evaluation of the conceptual, item, semantic equivalences showed that the Portuguese version is pertinent for the Brazilian context. Four of seven domains showed internal consistency above 0.70 (α: 0.76-0.90) and five of seven revealed intra-observer reliability (ricc: 0.41-0.70). This first Portuguese version of the HRQL questionnaire can be understood as a valuable tool for assessing children's HRQL, but further studies with large samples and more robust analyses are recommended before use in the Brazilian context.

Condições socioeconômicas e padrões alimentares de crianças de 4 a 11 anos: estudo SCAALA - Salvador/ Bahia

OBJETIVOS: identificar os padrões alimentares de crianças e sua associação com o nível socioeconômico das famílias. MÉTODOS: estudo transversal com 1260 crianças de 4 a 11 anos, residentes em Salvador-Bahia que incluiu aplicação de um Questionário de Frequência Alimentar semi-quantitativo. Os padrões alimentares foram identificados, empregando-se análise fatorial por componentes principais. O nível socioeconômico foi avaliado por meio de um indicador socioeconômico composto. Regressão logística multivariada foi empregada. RESULTADOS: identificaram-se quatro padrões que explicaram 45,9% da variabilidade dos dados de frequência alimentar. Crianças que pertencem ao nível socioeconômico mais alto têm 1,60 vezes mais chance (p<0,001) de apresentarem maior frequência de consumo de alimentos do padrão 1 (frutas, verduras, leguminosas, cereais e pescados) e 3,09 vezes mais chance (p<0,001) de apresentarem maior frequência de consumo dos alimentos do padrão 2 (leite/ derivados, catchup/ maionese/ mostarda e frango), quando se compara com aquele de crianças de nível socioeconômico mais baixo. Resultado inverso foi observado no padrão 4 (embutidos, ovos e carnes vermelhas); isto é, quanto maior o nível socioeconômico menor a chance da adoção desse padrão. Tendência similar foi notada para o padrão 3 (frituras, doces, salgadinhos, refrigerante/ suco artificial). CONCLUSÕES: padrões alimentares de crianças são dependentes das condições socioeconômicas das famílias e a adoção de itens alimentares mais saudáveis associa-se aos grupos de mais altos níveis socioeconômicos.

Lei n.º 11.889/2008: avanço ou retrocesso nas competências do técnico em saúde bucal?

O objetivo deste estudo foi analisar as competências que, desde a aprovação da lei n.º 11.889/08, incumbem ao técnico em saúde bucal (TSB) no Brasil, incluindo os termos definidos para sua supervisão. Foi realizada análise documental, comparando-se as competências definidas no referido instrumento legal com as previstas no parecer n.º 460/75 do Conselho Federal de Educação e na resolução n.º 63/2005 do Conselho Federal de Odontologia. Foram empregadas técnicas de análise temática considerando-se as habilidades em termos de ações diretas e indiretas distribuídas em quatro áreas de competência: planejamento e administração em saúde, promoção da saúde, prevenção de doenças e de assistência individual. Embora as competências aprovadas na lei tenham sido distribuídas em um número menor de itens, comparado aos dois outros documentos, do ponto de vista qualitativo, os resultados da análise permitiram concluir que vários avanços foram obtidos com a regulamentação da profissão, nos termos aprovados, em todas as áreas de competência. Houve impacto positivo para o processo de trabalho em saúde, tanto com relação à cooperação interprofissional quanto à supervisão técnica das atividades, representando uma conquista relevante dos trabalhadores da área e também uma contribuição significativa para avançar na ampliação do acesso aos serviços odontológicos