Amélia Duarte Machado, a Viúva Machado: a esposa, a viúva e a lenda na Cidade do Natal (1900-1930)

The research project examines representations elaborated about Amelia Duarte Machado, images that were built in a particular space: the Natal City. Amelia, one mossoroense that has a simple life, stated a luxurious life after marrying with a rich Portuguese merchant Manuel Machado, in 1904. She led a life of society lady, lived in a sumptuous residence, traveled to Europe, attending the Theatre the city and took care of the social image of her husband, opening the doors of your home to promote dinners and receptions. Experienced the changes occurring in Natal in the first three decades of the twentieth century, when the initiative of a political and intellectual elite of the city began to incorporate bourgeois values and to provide a technical framework focused on the improvements brought by the Industrial Revolution. In 1934, with her husband's death, took over the family business. Besides the widow, also became an enterprising woman. The widow Amelia Machado also became the target of suspicion of the population, rumors about his life. From there emerges a frightening figure in Natal, a being that captured and ate the liver of children, the papa-figo of Natal City, the Widow Machado. In this research, we relate different images that circulated about this woman, who was society lady, dashing widow and papa-figo, articulating these representations with the discourse on female circulating in Natal from 1900 to 1930 yet will raise hypotheses about the creation of the Legend of the Widow Machado

Impacto na epidemiologia da sepse tardia após a mudança do protocolo de antimicrobianos em uma UTIN de um serviço universitário

Advances in neonatology resulted in reducing the mortality rate and the consequent increase in survival of newborn pre terms (PTN). On the other hand, there was also a considerable increase in the risk of developing health care-related infection (HAI) in its most invasive, especially for bloodstream. This situation is worrying, and prevent the occurrence of it is a challenge and becomes one of the priorities in the Neonatal Intensive Care Unit (NICU). Sepsis is the main cause of death in critical neonates and affects more than one million newborns each year, representing 40% of all deaths in neonates. The incidence of late sepsis can reach 50% in NICUs. Currently the major responsible for the occurrence of sepsis in developed countries is the coagulase negative Staphylococcus (CoNS), followed by S. aureus. The cases of HAIs caused by resistant isolates for major classes of antimicrobial agents have been increasingly frequent in the NICU. Therefore, vancomycin has to be prescribed more frequently, and, today, the first option in the treatment of bloodstream infections by resistant Staphylococcus. The objectives of this study were to assess the impact on late sepsis in epidemiology III NICU after the change of the use of antimicrobials protocol; check the frequency of multiresistant microorganisms; assess the number of neonates who came to death. This study was conducted in NICU Level III HC-UFU. three study groups were formed based on the use of the proposed late sepsis treatment protocol, with 216 belonging to the period A, 207 B and 209 to the C. The work was divided into three stages: Period A: data collected from neonates admitted to the unit between September 2010 to August 2011. was using treatment of late sepsis: with oxacillin and gentamicin, oxacillin and amikacin, oxacillin and cefotaxime. Period B: data were collected from March 2012 to February 2013. Data collection was started six months after protocol change. Due to the higher prevalence of CoNS, the initial protocol was changed to vancomycin and cefotaxime. Period C: data were collected from newborns inteerne in the unit from September 2013 to August 2014. Data collection was started six months after the protocol change, which occurred in March 2013. From the 632 neonates included in this study, 511 (80,8%) came from the gynecology and obstetrics department of the HC-UFU. The mean gestational age was 33 weeks and the prevailing sex was male (55,7%). Seventy-nine percent of the studied neonates were hospitalized at the NICU HC-UFU III because of complications related to the respiratory system. Suspicion of sepsis took to hospitalization in the unit of 1,9% of newborns. In general, the infection rate was 34,5%, and the most frequent infectious sepsis syndrome 81,2%. There was a tendency to reduce the number of neonates who died between periods A 11 and C (p = 0,053). From the 176 cases of late sepsis, 73 were clinical sepsis and 103 had laboratory confirmation, with greater representation of Gram positive bacteria, which corresponded to 67.2% of the isolates and CoNS the most frequent micro-organism (91,5%). There was a statistically significant difference in the reduction of isolation of Gram positive microorganisms between periods A and C (p = 0,0365) as well as in reducing multidrug-resistant CoNS (A and B period p = 0,0462 and A and C period, p = 0,158). This study concluded that: the CoNS was the main microorganism responsible for the occurrence of late sepsis in neonates in the NICU of HC-UFU; the main risk factors for the occurrence of late sepsis were: birth weight <1500 g, use of PICC and CUV, need for mechanical ventilation and parenteral nutrition, SNAPPE> 24 and length of stay more than seven days; the new empirical treatment protocol late sepsis, based on the use of vancomycin associated cefepime, it was effective, since promoted a reduction in insulation CoNS blood cultures between the pre and post implementation of the Protocol (A and C, respectively); just as there was a reduction in the number of newborns who evolved to death between periods A and C.

Barriers to reporting child maltreatment: do emergency medical services professionals fully understand their role as mandatory reporters?

BACKGROUND: Child maltreatment is underreported in the United States and in North Carolina. In North Carolina and other states, mandatory reporting laws require various professionals to make reports, thereby helping to reduce underreporting of child maltreatment. This study aims to understand why emergency medical services (EMS) professionals may fail to report suspicions of maltreatment despite mandatory reporting policies. METHODS: A web-based, anonymous, voluntary survey of EMS professionals in North Carolina was used to assess knowledge of their agency's written protocols and potential reasons for underreporting suspicion of maltreatment (n=444). Results were based on descriptive statistics. Responses of line staff and leadership personnel were compared using chi-square analysis. RESULTS: Thirty-eight percent of respondents were unaware of their agency's written protocols regarding reporting of child maltreatment. Additionally, 25% of EMS professionals who knew of their agency's protocol incorrectly believed that the report should be filed by someone other than the person with firsthand knowledge of the suspected maltreatment. Leadership personnel generally understood reporting requirements better than did line staff. Respondents indicated that peers may fail to report maltreatment for several reasons: they believe another authority would file the report, including the hospital (52.3%) or law enforcement (27.7%); they are uncertain whether they had witnessed abuse (47.7%); and they are uncertain about what should be reported (41.4%). LIMITATIONS: This survey may not generalize to all EMS professionals in North Carolina. CONCLUSIONS: Training opportunities for EMS professionals that address proper identification and reporting of child maltreatment, as well as cross-agency information sharing, are warranted.

Social paranoia and absurdist fiction in Cold War America and Soviet Russia: a comparative study

This thesis explores the theme of social paranoia as depicted in the Absurdist fiction of Cold War America and Soviet Russia. The central hypothesis informing this research maintains that, despite the ideology of moral and cultural “Otherness” constructed and reinforced by both nations throughout much of twentieth century, the US and the Soviet Union more often than not functioned as mirror images of paranoia and suspicion. Much of the fiction produced in Russia from the Revolution onwards and in the US during the Cold War period highlights how these two ostensibly irreconcilable nations were consumed by similar fears and gripped by an equally pervasive paranoia. These parallel conditions of anxiety and mistrust led to a surprising congruity of literary responses, which transcended the ideological divide between capitalism and communism and, as such, underscored the homogeny of fear which lay beneath the façade of constructed difference. I contend that, because Soviet Russia and the America of the Cold War period were nations consumed by fear and suspicion, authors living in both countries became preoccupied by the mechanics of such deeply paranoid societies. Consequently, much of the fiction of the US and the Soviet Union during this period was preoccupied with the themes of paranoia, conspiracy, intensive bureaucracy and the politicisation of science, which resulted in the terror of the Nuclear Age. This thesis explores how these central themes unite apparently diverse literary texts and illustrate the uniformity of terror which transcended both the physical and ideological boundaries separating the United States and the Soviet Union. In doing so, this research focuses primarily on the multi-faceted manifestations of paranoia in selected works by Soviet authors Mikhail Bulgakov, Daniil Kharms and Yuli Daniel, and American authors Joseph Heller, Thomas Pynchon and Kurt Vonnegut. Focusing on key works by each author, this research considers these texts as products of two culturally diverse, yet equally paranoid societies and explores their preoccupation with issues of spying, infiltration and conspiracy. This thesis thus emphasises how these authors counter simplistic notions of Cold War Otherness by revealing two nations possessed by a similar sense of vulnerability and insecurity. Furthermore, this thesis examines how this social anxiety is reinforced by the way in which these authors position issues such as the mechanics of the bureaucratic system and clandestine scientific experimentation as the focal point of the paranoid imagination. Ultimately, by examining the concordance of paranoiac representation in America and the Soviet Union during this period, I demonstrate that these ostensibly divergent nations harboured similar fears and insecurities.

Crisis communication in politics: forgiveness as image restoration tool

Crisis communication is a widely treated field. There are lot of works and guides which provide helpful information in order to face crisis situations successfully (Alcat, 2005, Benoit, 1997) and articles about case studies (Nespereira, 2014, Blaney y Benoit 2001). Nonetheless, most of times, these guides are focused on business or corporations (Abeler, 2010) and there are not such information about crisis communications in politics (Gaspar e Ibeas, 2015). The field is smaller if we speak about forgiveness as restoration image tool in politics (Harris 2006). Despite all, we live in “forgiveness era” as Krauze said (1998) where people demand to politicians to apologize when they have mistakes (Harris et al. 2006:716). So, we will try to make an approach to forgiveness in politics as a image restoration tool and analyze its capabilities in order to face crisis management.

Temor, silencio y deliberación: la inhibición de la opinión en Tucídides

Tucídides es una de nuestras mejores fuentes de información para conocer la práctica argumentativa de la deliberación democrática. En este trabajo se analiza uno de los vicios que, según el historiador, haría su aparición en la escena política ateniense a la muerte de Pericles: la instrumentalización del miedo para obtener la victoria momentánea en la asamblea. El temor prudente, que fuera una arma periclea para conducir la deliberación racional en aras del bien común, habría desaparecido siendo sustituido por el amedrentamiento del rival, la calumnia, el obstruccionismo y la parálisis de la confrontación dialéctica. Instauradas en la ciudad la desconfianza y la sospecha de ocultación, los golpistas del 411 hallaron el terreno abonado para callar las voces contrarias y, gracias al silencio, instaurar el terror.

‘Should we try to Self Remember while playing Snakes and Ladders?’: Dr. Gambit as Gurdjieff in Leonora Carrington’s The Hearing Trumpet (1950)

Arising from the Paris surrealist group, the English-born writer and painter Leonora Carrington (England 1917 - Mexico 2011) was perpetually suspicious of orthodoxy and she often pokes fun at, parodies, and, ultimately, upsets traditional hierarchies of power. In her work animals impart wisdom, Goddesses loom large, and domestic spaces become sites of occult power. In this paper I will investigate Carrington's suspicion of gurus with claims to esoteric truth. Carrington participated in Fourth Way groups run by students of Gurdjieff (Christopher Fremantle) and Ouspensky (Rodney Collin). However, while she had a deep interest in the teachings, Carrington remained suspicious of the group practices of the Fourth Way, as can be seen in Elena Poniatowska’s fictionalised biography Leonora (2015). This articles explores Carrington's contact with the ‘Work’ in order to shed light on the character of Dr. Gambit in her 1950 novel, The Hearing Trumpet, commonly thought to be a parody of Gurdjieff. In doing so, it will investigate Carrington’s feminist objections to the role of the guru, while also contributing to a discussion of the unease some felt toward the praxis of the Fourth Way, despite their attraction to the philosophy.

Through Class Darkly: Class in the British TV Noir

Class has always been at the heart of the television crime drama. Whether it is the post-war paternalism of Dixon of Dock Green (1955 – 1976), the harsh social realism of The Sweeney (1975-1978), or the almost mythical evocations of Britain in Heartbeat (1992 – 2010) and Midsomer Murders (1997- present), class and crime have always been seen as being inextricably linked. Since the 1990s, the British crime drama has been influenced by successive waves of cultural imports from, firstly, the US and then from Scandinavia. There is now a recognisable ‘genre’ for what we might think of as British TV Noir. Beginning with shows such as Cracker (1993 – 2006), Prime Suspect (1991 – 2006) and Messiah (2001) and continuing with dramas like Red Riding (2008), Southcliffe (2013) and Hinterland (2013 – present), the British TV Noir employs narratives and stylistic tropes that might usually be associated with the cinema of the 1940s. Although drawing influence from high profile shows such as Twin Peaks (1990 – 1991), Millennium (1996) and (latterly) The Wire (2002 – 2008), CSI (2000 – present) and The Killing (2007) these British Noir shows also articulate the nation’s shifting class system. As Susan Sydney-Smith has ably demonstrated, the crime drama is “historically contingent” (Sydney-Smith, 2002, p. 5) and shaped by the surrounding socio-political, as well aesthetic, context. To this end, this chapter traces the depiction of class in three key crime series – Prime Suspect, Red Riding and Southcliffe - and explores how social class, and more importantly, its changing face provides a constant background to the narratives and characterisations. These three texts were each produced at pivotal moments in Britain’s relationship to class – Prime Suspect was shown 6 months after Margaret Thatcher vacated office; Red Riding was produced in the midst of the global recession in 2008 and Southcliffe was made in the shadows of stringing welfare and immigration reforms. These texts span three successive political administrations and over two decades of social and political change. Understanding the relationship between criminal activity and class in these dramas however is far more complicated than simply reading the historical context through the text. Commensurate with its cinematic incarnation, TV Noir is both reflective and productive, employing visual and narrative tropes to manipulate, as well reflect, its audience’s moral and social positioning. The picture that emerges from an examination of class and the British TV Noir is one of suspicion and discontent. As Andrew Spicer suggests (with reference to British cinema) the Noir sensibility both depicts and critiques a society that it sees as being “class-ridden, racist and misogynist” (Spicer, 2002, p.202). This is certainly the case with the texts that are being examined here, as social positions and taxonomies are constantly being redefined and renegotiated.

Brooke-Spiegler Syndrome - an underrecognized cause of multiple familial scalp tumors: report of a new germline mutation

BACKGROUND: Brooke-Spiegler syndrome (BSS) is probably an underdiagnosed genodermatosis that predisposes for the development of cylindromas, spiradenomas and trichoepitheliomas mainly of the head and neck. Wide phenotypic variability regarding the number and type of lesions can be observed within a family. Mutations of the CYLD gene are identified in the vast majority of cases and play a key role in BSS pathogenesis. MAIN OBSERVATIONS: Two first degree relatives with numerous erythematous telangiectatic nodules of the scalp present for decades, with recurring tendency regardless the multiple previous excisions. Histopathological review of the lesions revealed predominantly "spiradenocylindromas" in the proband and cylindromas in her sister. The suspicion of BSS was confirmed after detection of a new nonsense germline mutation of CYLD (c.1783C>T pGln 595*) in the proband. CONCLUSIONS: BSS diagnosis can be challenging and is based on clinical-pathological correlation, positive familial association and identification of CYLD mutations. CYLD exerts antineoplastic effects by downregulating intracellular NF-κB signalling pathways. The reported mutation affecting the ubiquitin-specific protease domain leads to a truncated and catalytically inactive enzyme. Despite the expanding list of CYLD mutations no firm genotype-phenotype correlation is known so far. Early recognition and treatment of BSS avoid disfiguring changes like "turban tumor".

Usefulness of ultrasounds in the management of breast phyllodes tumors

Introduction. Breast phyllodes tumors (PT) are uncommon fibroepithelial lesions having potential malignant features. These tumors have characteristic features, like phleomorphism, mitoses and overgrowth of the stroma with possible infiltrative margins. The clinical behaviour could be unpredictable, since the relatively high recurrence rate despite correct surgical strategy. Conventional diagnostic examinations show high sensitivity and specificity, but cannot demonstrate the differences between benign and malignant PT. MRI is not more effective. Patients and methods. Sixteen patients affected by PT have been surgically treated at our Institution. All patients received mammography and ultrasonography (US) as preoperative diagnostic work-up. Results. in 13 patients, US was effective in preoperative diagnosis of PT. Mammography was uneffective in detecting breast lesions in 5 cases, while in 11 cases mammographic findings presented benign features, with a round opacity with moderate tissue density and well-defined wall. Conclusion. US remains the most useful diagnostic test in detecting PT. However, there is no test effective in identifying malignat PT. In case of suspicion, fine needle biopsy should be performed.

Determinación de coliformes totales y E. Coli en muestras de lechuga expendidas en cuatro mercados de la ciudad de Cuenca

A nivel mundial, existe una tendencia hacia el mayor consumo de frutas y hortalizas, motivada por una creciente preocupación de adoptar una dieta más equilibrada. Sin embargo su imagen de alimentos sanos las excluyen de toda sospecha cuando existen problemas de salud debido a la ingestión de alimentos. El objetivo de la presente tesis fue determinar la presencia de coliformes totales y E. coli en lechugas variedad Iceberg que se expenden en cuatro mercados de la ciudad de Cuenca. Los resultados obtenidos sirvieron como aporte al Departamento de Higiene y Control de Mercados del Ilustre Municipio de Cuenca. Este estudio fue de tipo descriptivo longitudinal. Se analizó un total de 96 muestras por duplicado y se realizó la determinación de coliformes totales y Escherichiacoli, mediante la técnica de placas PetrifilmTM. El grado de contaminación de las lechugas fue tolerable ya que solo el 1% de las muestras estuvo contaminada con niveles no aceptables de coliformes totales y el 6,25% con niveles no aceptables de E. coli, según la Recopilación Internacional de Normas Microbiológicas de los Alimentos y Asimilados de Pablo Moragas y col. Además, no se encontró ninguna relación significativa entre el mercado y el lugar de producción con el grado de contaminación de las lechugas. A pesar de la baja prevalencia de contaminación encontrada, la presencia de indicadores de contaminación fecal sugiere que las lechugas podrían tener una inadecuada calidad microbiológica, representando una fuente de ETAs, si la contaminación no es controlada mediante buenas prácticas de higiene

Brooke-Spiegler Syndrome - an underrecognized cause of multiple familial scalp tumors: report of a new germline mutation

BACKGROUND: Brooke-Spiegler syndrome (BSS) is probably an underdiagnosed genodermatosis that predisposes for the development of cylindromas, spiradenomas and trichoepitheliomas mainly of the head and neck. Wide phenotypic variability regarding the number and type of lesions can be observed within a family. Mutations of the CYLD gene are identified in the vast majority of cases and play a key role in BSS pathogenesis. MAIN OBSERVATIONS: Two first degree relatives with numerous erythematous telangiectatic nodules of the scalp present for decades, with recurring tendency regardless the multiple previous excisions. Histopathological review of the lesions revealed predominantly "spiradenocylindromas" in the proband and cylindromas in her sister. The suspicion of BSS was confirmed after detection of a new nonsense germline mutation of CYLD (c.1783C>T pGln 595*) in the proband. CONCLUSIONS: BSS diagnosis can be challenging and is based on clinical-pathological correlation, positive familial association and identification of CYLD mutations. CYLD exerts antineoplastic effects by downregulating intracellular NF-κB signalling pathways. The reported mutation affecting the ubiquitin-specific protease domain leads to a truncated and catalytically inactive enzyme. Despite the expanding list of CYLD mutations no firm genotype-phenotype correlation is known so far. Early recognition and treatment of BSS avoid disfiguring changes like "turban tumor".

Tumores do espaço parafaríngeo: experiência de 10 anos do IPO-LFG

Introdução: As neoplasias do espaço parafaríngeo são raras, representando apenas 0,5% dos tumores da cabeça e pescoço. A maioria são benignas, mas uma ampla variedade de patologias benignas e malignas podem ser encontradas neste espaço, o que cria desafios complexos de diagnóstico e tratamento. Objetivo: Descrever e analisar uma série de casos de neoplasias primárias do espaço parafaríngeo tratadas no Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG). Material e métodos: Estudo retrospetivo, com recolha e análise dos dados dos processos clínicos de tumores primários do espaço parafaríngeo, que foram diagnosticados ou referenciados ao IPOLFG entre 1 de Janeiro de 2003 e 31 de Dezembro de 2013. Resultados: Foram incluídos 38 doentes. A idade mediana foi de 52 anos (Âmbito Interquartil: 40-63 anos). Dez (26,3%) doentes eram assintomáticos. O sintoma mais comum à apresentação foi a sensação de corpo estranho orofaríngeo (23,7%) e o achado mais frequente foi um abaulamento orofaríngeo (78,4%). Todos os doentes fizeram exames de imagem pré-operatórios: 94,7% tomografia computorizada e 68,4% ressonância magnética. A citologia aspirativa foi realizada em 39,5%. 31 tumores eram benignos (81,6%), sendo os mais frequentes os adenomas pleomórficos (58,1%). 7 eram malignos (18,4%), com os carcinomas exadenomas pleomórficos (28,6%) e os linfomas (28,6%) sendo os mais comuns. 36 doentes (94,7%) foram submetidos a tratamento cirúrgico primário; os outros 2 doentes (5,3%) receberam tratamento não cirúrgico, com quimioterapia e quimioradioterapia, respectivamente. A abordagem cervical foi a mais utilizada (80%). A mandibulotomia foi necessária em apenas 5,7%. A complicação mais frequente foi a neuropatia de pares cranianos de novo, identificada em 22,2%. Destes, 75% foram sequela da resseção de tumores neurogénicos. Todas as neuropatias que resultaram da resseção de tumores não neurogénicos foram transitórias. O follow-up mediano foi de 6,5 anos. A taxa de recorrência foi de 13,5%. Conclusões: Os tumores do espaço parafaríngeo requerem um elevado índice de suspeição para serem diagnosticados num estadio precoce. A resseção cirúrgica completa é o principal tratamento. A abordagem cirúrgica deve ser selecionada caso a caso, mas a cervical fornece um excelente acesso à maioria dos tumores deste espaço

Free-Floating Thrombi in the Right Atrium Causing Pulmonary Embolism

A 74-year-old man presented to our Emergency Department with acute dyspnoea. His electrocardiogram showed atrial flutter with 2:1 block and a rate of 150 bpm. Initial investigations revealed a D-dimer level of 6.01 mg/dl. Based on the patient’s complaints and the high D-dimer level, computed tomography pulmonary angiography was immediately performed. This showed no evidence of pulmonary embolism, but there were pneumatic changes in the right upper lung lobe. Antibiotics treatment was started with pipracillin/tazobactam, after which the patient’s condition improved. However, on the third day after admission he developed acute dyspnoea, diaphoresis and cardiopulmonary instability immediately after defecation. To promptly confirm our clinical suspicion of pulmonary embolism, a transthoracic echocardiography was carried out. This demonstrated a worm-like, mobile mass in the right heart. The right ventricle was enlarged, and paradoxical septal motion was present, indicating right ventricular pressure overload. The systolic tricuspid valvular gradient was 56 mmHg. The patient was treated with thrombolysis. His condition was greatly clinically improved after 3 hours. After 10 days of hospitalization, the patient was discharged.

Non-acute Transient Reversible Adrenal Insufficiency in a Survivor of Critical Illness: A Lesser-known Cause of Primary Adrenal Insufficiency

Objectives: Primary adrenal insufficiency AI is regarded as a progressive disease needing lifelong replacement therapy, but this may not always be the case. Material and methods: A non-acute presentation of AI following a hypotensive episode caused by blood loss was investigated. Results: Adrenal function fully recovered without treatment. Conclusions: There should be a high index of suspicion and a low threshold for performing tests of adrenal function in survivors of critical illness and severe hypotensive episodes.