The Challenges of Antimicrobial Resistance in Brazil

Brazil is a country with continental proportions with high geographic and economic diversity. Despite its medical centers of excellence, antimicrobial resistance poses a major therapeutic challenge. Rates of methicillin-resistant Staphylococcus aureus are up to 60% and are related to an endemic Brazilian clone. Local resistance to vancomycin in Enterococci was first related to Enterococcus faecalis, which differs from European and American epidemiology. Also, local Klebsiella pneumoniae and Escherichia coli isolates producing extended-spectrum beta-lactamases have a much higher prevalence (40%-50% and 10%-18%, respectively). Carbapenem resistance among the enterobacteriaceae group is becoming a major problem, and K. pneumoniae carbapenemase isolates have been reported in different states. Among nonfermenters, carbapenem resistance is strongly related to SPM-1 (Pseudomonasaeruginosa) and OXA-23 (Acinetobacter baumannii complex) enzymes, and a colistin-only susceptible phenotype has also emerged in these isolates, which is worrisome. Local actions without loosing the global resistance perspective will demand multidisciplinary actions, new policies, and political engagement.

Re-thinking bilingualism : challenges of multilingualism and communication in classroom settings

Editors’ preface to the special issue of the journal.

The challenges of repositioning an international brand: a case study on the hospitality industry

Much has been said in the literature about brand positioning, as well as about international branding and their importance on ever more competitive world marketplaces. Concerning repositioning, however, the literature is not extensive, and if the subject has been considered by a few scholars, it has been, as Ryan, Moroney, Geoghehan and Cunnigham (2007) noted “in passing” and “without elaboration”. It is nevertheless considered as an integral part of “strategic competition” (Porter, M., 1996, as cited in Ryan, P., Moroney, M., Geoghegan, W., Cunningham, J., 2007), as well as an element indispensable to corporate transformation (Dunphy, D., Stace, D., 1993, as cited in Ryan, P., Moroney, M., Geoghegan, W., Cunningham, J., 2007). Investigating it further, looking at it in an international setting, and understanding what challenges can arise when an international firm engages in such practice is thus of interest. This is conducted looking at the recent repositioning of Accor´s brand Sofitel from the high-end to the luxury market segment of the hospitality industry.

Open innovation and the challenges of human resource management

This paper considers challenges of Human Resource Management (HRM) in Open Innovation processes. It examines which strategies managers used to overcome these problems in the case of the Brazilian Oil and Gas company Petrobras. By conducting an inductive case study it develops a contextual model based on the use of grounded theory. It argues that the most important categories were to overcome problems of (a) the interpersonal relationship, (b) power shifting inside the organization, and (c) making people more valuable to the organization and shows how managers tackled these challenges. It contributes with a deep analysis of HRM challenges in Open Innovation that is important for a better understanding of management problems that can come along with Open Innovation processes.

Involving users to successfully meet the challenges of the digital library: a 30 year personal reflection

Trabalho apresentado na conferência Os Desafios das Bibliotecas Digitais realizado na Fundação Getulio Vargas em agosto 2014

PET containers in Brazil: Opportunities and challenges of a logistics model for post-consumer waste recycling

The use of post-consumer materials is directly related to reducing the cost of production and extraction of natural resources. Non-recyclable materials are randomly disposed in the environment. Brazil is one of the largest consumers of PET (polyethylene terephthalate) bottles. The purpose of this paper is to describe the opportunities and challenges of the logistics model for post-consumer PET bottle recycling in Brazil, while providing knowledge of its practices along the recycling chain. The results describe the need to educate those directly and indirectly involved in the process: to reduce consumption in order to reduce the amount of waste generated: to structure the post-consumer reverse chain and engage industrial sectors and government, through public policies, to support cleaner technologies along the PET bottle production chain. (C) 2010 Elsevier B.V. All rights reserved.

Evaluation of different occlusal splints and counselling in the management of myofascial pain dysfunction

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Carprofen and buprenorphine prevent hyperalgesia in a model of inflammatory pain in cats

A model of nociceptive threshold determination was developed for evaluation of NSAID analgesia in cats. In a crossover study, eight cats received carprofen (4 mg/kg), buprenorphine (0.01 mg/kg) or saline (0.3 ml) subcutaneously before intradermal kaolin injection on the antebrachium to induce mild inflammation. Pressure thresholds were measured at the injected site using blunt-ended pins advanced by manual inflation of a bladder within a bracelet. Bladder pressure was recorded as threshold (PT) at the behavioural end point. Baseline PT were recorded before kaolin injection (time 0). PT was measured at 2-10 h intervals for 52 h. PT below the lower 95% confidence interval (CI) of baseline values indicated hyperalgesia. After saline, hyperalgesia was detected from 2-6 h, 22-26 h, and at 30 and 36 h. After carprofen, PT remained within the 95% CI. After buprenorphine, PT remained within the 95% CI except at 2 h. Carprofen and to some extent buprenorphine, prevented inflammatory hyperalgesia. (C) 2007 Elsevier Ltd. All rights reserved.

Challenges of modeling depth-integrated marine primary productivity over multiple decades: A case study at BATS and HOT

The performance of 36 models (22 ocean color models and 14 biogeochemical ocean circulation models (BOGCMs)) that estimate depth-integrated marine net primary productivity (NPP) was assessed by comparing their output to in situ (14)C data at the Bermuda Atlantic Time series Study (BATS) and the Hawaii Ocean Time series (HOT) over nearly two decades. Specifically, skill was assessed based on the models' ability to estimate the observed mean, variability, and trends of NPP. At both sites, more than 90% of the models underestimated mean NPP, with the average bias of the BOGCMs being nearly twice that of the ocean color models. However, the difference in overall skill between the best BOGCM and the best ocean color model at each site was not significant. Between 1989 and 2007, in situ NPP at BATS and HOT increased by an average of nearly 2% per year and was positively correlated to the North Pacific Gyre Oscillation index. The majority of ocean color models produced in situ NPP trends that were closer to the observed trends when chlorophyll-alpha was derived from high-performance liquid chromatography (HPLC), rather than fluorometric or SeaWiFS data. However, this was a function of time such that average trend magnitude was more accurately estimated over longer time periods. Among BOGCMs, only two individual models successfully produced an increasing NPP trend (one model at each site). We caution against the use of models to assess multiannual changes in NPP over short time periods. Ocean color model estimates of NPP trends could improve if more high quality HPLC chlorophyll-alpha time series were available.

Clinical evaluation of amitriptyline for the control of chronic pain caused by temporomandibular joint disorders

Temporomandibular disorder (TMD) is characterized by a combination of symptoms affecting the temporomandibular joint and/or chewing muscles. The two most common clinical TMD symptoms are pain and dysfunction. Pain is usually caused by dysfunction, and emergency therapy has focused on controlling it. Recent investigations into TMD have led to the recommendation of antidepressants as a supporting treatment against constant neuralgic pain. The aim of this double-blind study was to verify the efficiency of antidepressants (amitriptyline) as a support in the treatment of chronic TMD pain. Twelve female volunteers presenting chronic TMD pain were divided into two groups and treated for 14 days: Group 1 with 25 mg/day of amitriptyline and Group 2 with a placebo. The intensity of pain and discomfort was evaluated daily, using a visual analog scale (VAS), over a period of seven days preceding the treatment (baseline), during the 14-day treatment, and for seven days after the treatment. The results revealed a significant reduction of pain and discomfort in Group 1 (75%) compared to Group 2 (28%) during the three weeks beginning at baseline (p< 0.01). Amitriptyline proved to be an efficient alternative treatment for chronic pain in TMD patients. Copyright © 2003 by CHROMA, Inc.

The frequency of pharmacological pain relief in university neonatal intensive care units

Objective: To evaluate the use of drugs to relieve the pain of invasive procedures newborn infants cared for at a university hospital NICU. Methods: A prospective cohort study of all newborn infants hospitalized in four NICU during October 2001. The following data were collected: demographic data of the hospitalized newborn infants; clinical morbidity; number of potentially painful procedures and frequency of analgesic administration. Factors associated with the use of analgesia in this cohort of patients were studied by multiple linear regression using SPSS 8.0. Results: Ninety-one newborn infants were admitted to the NICU during the study period (1,025 patient-days). Only 25% of the 1,025 patient-days received systemic analgesia. No specific drugs were administered to relieve acute pain during any of the following painful events: arterial punctures, venous, capillary and lumbar punctures or intubations. For chest tube insertion, 100% of newborn infants received specific analgesia. For the insertion of central catheters 8% of the newborn infants received painkillers. Only nine of the 17 newborn infants that underwent surgical procedures received any analgesic dosage during the postoperative period. For 93% of patients under analgesia the drug of choice was fentanyl. The presence of mechanical ventilation increased the chance of newborn infants receiving painkillers by 6.9 times and the presence of chest tube increased this chance by five times. Conclusion: It is necessary to train health professionals in order to bridge the gap between scientific knowledge regarding newborn infant pain and clinical practice. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Macroeconomic challenges of fiscal decentralization

Includes bibliography